v9.1

AGENCY :..
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RECORD SERIES :

AGENCY FILE NUMBER :

ORIGINATOR :
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TO:

TITLE: ©

DATE:
PAGES:

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DOCUMENT TYPE :
CLASSIFICATION :
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JFK Assassination System . Date:

Identification Form

Agency Information

HSCA .
180-10073-10093

NUMBERED FILES
004876

Document Information

RUBY, SAMUEL
RUBY, SAMUEL

01/24/1978
118

RUBY, SAM
RUBY, JACK, BACKGROUND, ASSOCIATES AND RELATIVES

OTHER TEXTUAL
Unclassified

3

Redact

10/25/1995

W/cover letter. Box #:102.

NW 88326 Docid:32245535 Page 1

10/1/201

162L50 Burcher Ave TAn . AEG TE
Wills, CR.
Granada LMS,

004876.

af | ae, oD imal


7 , be deb = we . . “F yb .
"stan 5399 Return for Indiv’ ily 1978 «

, Form. J Retirement Savings Arrangement UIE

- Bopertiont’ at tho Treasury (Under. Sections 408 or 409 of the Internal. Revenue Code) Only This Side of Form is

")., Igtornal Revenuc Service
r .

> Attach to Form 1040. — Open to Public Inspection-

-If you have established a retirement savings arrangement you must p Part | and Part Il and ‘attach this
form to your individual income tax return, Form 1040. In addition: (1) if you claim a deduction on your Form 1040
for contributions to your retirement savings arrangement, complete Part Ill; (2) if you have made contributions in
excess of your allowable limitation for this year or prior years, complete Part IV; (3) if you are not yet age 5914
when you receive a diStribution from your retirement savings arrangement which is not due to a disability,.a-rollover
contribution to another plan or retirement savings arrangement, or the transfer of an amount to a former spot
under a divorce decree, you must complete Part V; (4) if you are 701% or older on the last day of the year, : see: in-
structions to determine if you are required to complete Part VI.

t , i
te . Name ol. . vA

Address (Number ‘and street)

et

City or town, State and ZIP code
G Cer

If you are not required to file a Form 1040 check here

MRar.ty lai Individual and Retirement Savings Information , ae

1 Type of individual retirement savings arrangement:

(a) [J Individual retirement account
(b) [[] Individual retirement annuity
(c) [7] Individual retirement bonds

2 Were you during any part of the year an active participant in a qualified pensi atk on sharing
plan, including a qualified Keogh (HR 10) plan, or were you covered under a sactio' 403(b) annuity.
account or under a government*retirement plan other than the Social Security ¥ Railroad Retin
(Volunteer firemen and military reservists see specific instructions for line 2) . Nw

ial,

If ““Yes,"’ you are not allowed a deduction for your 1976 contributions to your indivi

Under penalties of perjury, | declare that | have examined this return, including accompanying- sche S22
knowledge and belief it is true, correct, and complete. If prepared by a person other than the taxpayer, this this declay
of which the preparer has any knowledge. : ‘

_ ee IEAM MY T

fe r i other than taxpayer: Preparer’s identification number. 5 : a
. “Prepa er's signature ( J taxpayer) _(see General Instruction B) Rate “ i oe

.~ Preparer’s address‘and ZIP code


Lehi Dig ence meneame eh ie te te eee Eh tet ME a id Pi oy eee

filed by surviving spouse or - beneficiary ofa an individual who created this retirement savings arrangement check here > oO

nd enter name arid social security number of individual for whom the arrangement was established b>

di ste-your age as of the end of the year (If you checked item 3 do not complete this item):

a: ji
= (a) ci Under age-591%
“(b) Age 5914 to 7044"
(ce) ©) Over age 7034 (if you check item: *(c) complete Part VI below)

5 (a) if during the year, you received a distribution of your entire account from a qualified pension, profit
sharing or stock bonus plan, because either (i) you terminated employment or (ii) your employer .
terminated the plan, and you transferred (rolled over) such distribution to your arrangement, check here . . . e oO

(b) If you checked (a) did you transfer the entire amount of the distribution (less any amounts you con-
tributed to the qualified plan—see instructions) to your arrangement within 60 days of receipt of such .
distribution (or 12/31/76 if (a)(ii) applies and you received such distribution prior to 11/2/76)?. . . [J Yes [ No

(c) If (b) was “Yes,” complete lines (i) through ii) below: Month j Day | Year
(i) Date of transfer to arrangement . . . ee eee bk be ee ee ;

(ii) Date distribution was made to you from tre plan eee ee ew ew tt tt lke
ii) Name of trustee or insurance compeny to which the transfer was made (If bonds were purchased state “Bonds”) b>...

(d)’ (i) ‘if within one taxable year, you received a distribution of your entire “account from your employer's qualified pension,
“profit-sharing or stock bonus plan because the plan was terminated by your employer did you:
(A) receive such amount on or after July 4, 1974 but prior to January 1, 1976,
(B) transfer such amount, reduced Ly the amount of the income tax paid on the distribution on ©
your 1974 or 1975 income tax return, to an arrangement and
(C) tite a claim for refund of such tax paid? (Check “Yes” only if (A), (B) and (C) ALL apply.) . (J Yes ( No
=

? (ii) if (d)(i) is ‘‘Yes,"’ and you have received such refund or credit for such tax paid enter: Month: Day | Year
4 (A) Date refund or credit received 2. 2. 1 1 1 ew we ew ee te kk oe 6

“(B) Date refund or amount of credit was contributed to your retirement savings arrangement . .
Note: See Definition C in the Instructions concerning rollover contributions,

"6 If, during the year, you transferred any funds from one retirement savings arrangement to another retire-
ment savings arrangement, enter the date of transfer here. . . . . . 2. es ws we tb we .
Caution: Such a transfer may be a taxable distribution. a

7 If, during the tax year covered by this form, you have entered into a prohibited transaction under section 4975 or borrowed any amount from
your retirement savings arrangement or pledgéd any part of your arrangement as security for a loan, check here . . i |
Note: See instructions for the tax consequences of such transactions.

Abarth) Computation of Allowable Deduction.

(If you have entered into a prohibited transaction: under section 4975, do not complete Part [Il or Part
W for the retirement savings arrangement with which you entered into such prohibited transaction.) _

8 Wages, tips and other compensation from Form 1040 (if a joint returri do not include compensation of spouse) H
(See definition B in the instructions for the meaning of compensation.). . es Sen
9 15% of line 8 or $1,500, whichever is lesser (if you are 701% or over or answered “Yes” to line 9 enter zero). .« 2 «© «© eo fo _—_ ee nnn
10 Amount paid by you or on your behalf under all your retirement savings arrangements (do not include any
amounts which were considered as “rollover contributions,” see lines 5 and 6, or the purchase price of any

individual retirement bonds redeemed within 12 months of their date of purchase (see instructions) or life cS .
insurance Portion of your endowment premium as reported on Form 5498 box6). 2. «2... . . Le

Nentn| Day { Year

11 Allowable deduction, lesser of line 9 or line 10 (enter here and on Form 1040, line 40a)... . - > So ’
.Getniiy..| Tax on Excess Contributions ee
12 Tax on excess contributions (see Part IV of the Specific Instructions if Part lil, line 10 exceeds line 11). Enter

tax from worksheet here and on Form 1040, line 61 7. oe . 5 - >
(Temy:.:] Tax on Premature Distributions

13 Tax on premature distributions (see Part V of the Specific Instructions if you received a distribution from

your retirement savings arrangement before you have attained age £9%A). Enter tax from worksheet here and
on Form 1040, line 57. . . . . ee ee ee

Fj Tax on Undistributed Retirement Accounts and Annuities
(See Instructions before completing this Part.)

14 Tax based on current year distribution method, see worksheet in Instructions . . . . . ee ee
15 Tax based.on aggregate distribution methods, see worksheet in Instructions . . . . oe eo we

16 Tax due, lesser of line 14 or 15, enter here and on Form 1040, in your total for line 62. On the dotted line to
the left of the line 62 entry space write ‘'4974 tax,” and show the amount oe ee le

WW U.S, GOVERNMENT PRINTING OFFICE : 1976—O-218-176 ELI. 13.2687299

4


: Department of the Treasury— internal Revenue Service
' 040 U.S. Individual Income Tax Return
For thé year January” 1—December 31, 1976, ¢ or. other taxable year beginning _ _ "1976 ending —_ 19

Name (If joint return, give first names and initials of both)

iP \ ‘ir

| For Péivac
| see page 5 of Instructions.

5 Oceu- |_Yours
a? tar, pation | Spouse's p>
1 Single (Check only ONE box) 6a Regular (J Yourself [—] Spouse Enter Chee p> yy
2 arried filing joint return (even if only one had income) b First names of your dependent children who Z Yy, :
2 3 Married filing separately. If spouse is also filing give a lived with you eS td S &} _———____ 7
= 1 i i i j = pn Eee Ent
FE] spouses Social security number in designated space above s THor "Ky 5 Aumber > _
. J name here p> =| ¢ Number of other dependents (from line 7) . > i_ Ui
E | 0 Unmarried Head of Household. See page 7 of instructions Rs] d Total (add lines 6a, b, andc) . .
este ty > e@ Age 65 or older. O Yourself [7] Spouse Enter ;
5 [] Qualifying widow(er). with dependent child (Year Blind. . . . [] Yourself [] Spouse gf paxes b>
spouse died > 19 ). See page 7 of Instructions. _f TOTAL (add lines 6d and e) woe . Bb :
' . 7 Other dependents: (b) Relationship (c. Months lived in your (a) Did dependent (e) Amount furnished for dependent’s support ~
an : (a) Name ; during year, write B or D. or more? of $75 By. You. It 100% ry Set eRS includ:
$d
. . ae Of . : “ ”
8 Presidential Election Do you wish to designate $1 of your taxes for this fund? . . {__} Yes. 7 No _| fontes) it'will not increase our
Campaign Fund . . If joint return, does your spouse wish to designate $1? Yes Y No _| tax or reduce your refund.
9 Wages, salaries, tips, and other employee compensation ‘Attgch_ Forms W-2. If ungall en f:) -p ~ . :

able, see page 6 of Instructions.) *

7 10a Dividends Teo ee uations wecceeeeeeee cee a , 10b less exclusion. Balance f> | 10¢). . GQ —— —_——
(if gross dividends and other distributions are over $400, list ir rt lof Schedule B.) r : :
11 + Interest income. {if Gver $400, enter total and Int ie Part ot Seheakle B cee faa SES
£ ‘12 Income other than wages, dividends, and interest (from line 37) . . . . . .. 120 _—_——
$| 13 Total (add lines 9, 10c, ll and 12)... . . cee ee LE ADAG fe)
“| 14 ‘Adjustments to income (such as moving expense, ete. from line 42) se ee ee 4 ca - inal ——-

b Disability income exclusion (sick pay) (attach Form 2440) toe eee 15b_ _ ae —t#
c Adjusted gross income. Subtract line 15b from line 15a, then complete Part MI on back. , “:
(If less than $8,000, see page 2 of Instructions on ‘“‘Earned Income Credit.”) . . . . | 15¢| - 7 > \f }

{| Tax Table Tax Rate Schedule X, Y or Z| | Schedule D| | ‘ . -
Schedule G Form 2555 | TO Form 4726 |_16 oe

16 Tax, check if from:

Please attach Copy B of Forms W-2 here

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is
true, correct, and complete. Declaration of preparer (other than taxpayer) is based’on all information of which Preparer has any knowledge.

17a Multiply $35.00 by the number of exemptions on line 6d . 17a — 4 seo page 10 Of} sstpuetions)
|B Enter 2% of line 47 but not more than $180 ($90 if box 3 is checked) vs | W¥o ofa! | 17c¢ — 2G
3 18 Balance. Subtract line 17¢ from line 16 and enter difference (but not less than zero) :
L- S| 19 Credits (from line 54) : .
| 20 Balance. Subtract line 19 from line 18 and enter 1 difference (but not less than zero)
z 21 ~~ Other taxes (from tine 62) ee :
a 22 Total (add lines 20 and 21). . Soe ee ee ae (
i s E 23a Total Federal income tax withheld. "{atagh, Forms frosts , | 43a. m0
ra = b 1976 estimated tax payments . qe credit from, 1975 woken 23b_ 8 full ith this return. Write )
z c Earned income credit. of ‘Instructions) Son ee 23c_ Y check or money order and Y
° ‘d Amount paid with Form 4868 . . 2. 2. 1... «| 23d = Rover ee inert 7)
2 e Other payments (from line 66) . . . . 3 0. ; [23e Yyjyyypyywyw@—

'“s 24 TOTAL (add lines 23a through e) woes wos

~ 8 (| 25 If line 22 is larger than line 24, enter BALANCE DUE IRS... - . > [25- a
3 3 " (Check here [> ["], if Form 2210 or Form 2210F is attached. See page 10 of instructions.) .
ra] ra 26 If line 24 is larger than line 22, enter amount OVERPAID: eee ee ee Bm IRB .

.3| 8] 27 . Amount of line 26 to be REFUNDED TO YOU . . ‘ wes) yb 7 27 ede Dn|
= ©] 28° Amount of line 26 to be credited on 1977 estimated tax b> [ 28 |. —} | WHHE: YWVHE@V]V}@#Uyyi
y
8
a

our ‘signatira ° Date ID meer Preparer’s signature (and employer's name, if any) Sé@Date Signature {and employer's name, if any) . Date

Span s signature (if filing “alas, BOTH must sign even if only one had income) _|> Tdentitying Number (see instructions) y Address (and ZIP code)

~ Sign here

NW 88326 Docld: 32245535 Page 5

15a Subtract line 14 from line 13... . 1. PA A

a 4 218-052-2


NER deeria reuse ear a ek oF ema
Emr. é : ee ire

a

Form 1040 4976) . wht page 2
“7Tncome other than Wages, Dividends and Interest : ;

+ 29 Business income or (loss) {attach Schedule C) . . . - oo ee ee [29
. 30a Net gain or (loss) from sale or exchange of capital assets (attach Schedule b) woe ee . [30a 7) ’
b 50% of capital gain distributions (not reported on Schedule D—see page 10 of Instructions). _30b" _
. 31 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) . . . 31 __
: 32a Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) . 32a —_——
b Fully taxable pensions and annuities (not reported on Schedule E—see page 10 of Instructions) _32b° _
“33 Farm income or (loss) (attach Schedule F) re __.

‘ does not apply if refund. is for year in which you took the
, 34 State income tax refunds ( standard deduction—others see page 10° of Instructions ) .

q
|

35 Alimony received . . - - rr | 35 |
36 Other (state. nature and source—see page rT of Instructions) >. ; . |

Total add lines 39 through 36). Enter here and online 12
Piet] Adjustments to Income

38 Moving expense (attach Form 3903) soa
39 Employee business expense (attach Form 2106) . . . cos
-- 40a Payments to an individual retirement arrangement from attached Form 5329, Part i,
b Payments to a Keogh (H.R. 10) retirement plan :

. 41 Forfeited interest penalty for premature withdrawal (see page 12 of Instructions) oka
' 42> Total (add lines 38 through 41). Enter here and on line 14 Coe ee

PTE] Tax Computation

43 Adjusted gross income (from line 15c). if you have unearned income and can be claimed as a
. dependent on your parent's return, check here Pm Eja and see page 9 of Instructions
i 44a If you itemize deductions, check here > C) and enter total from Schedule A, line 40, and attach Schedule A
a b Standard deduction—If you do not itemize deductions, check here > [_], and:
= ~ If you checked 2 or 5, enter the greater of $2, 100 OR 16% of line 43—but not more than $2, 800
the box on 1 or 4, enter the greater of $1, 700 OR 16% of line 43—but not more than $2, 400
line 3, enter the greater of $1,050 OR 16% of line 43—but not more than $1,400
45. Subtract line 44 from line 43 and enter difference (but not less than zeroy 2. 6 1 we we
‘46° Multiply total number of exemptions claimed on line 6f by $750 :
‘ 47 Taxable income. Subtract line 46 from line 45 and enter difference (but not less than zero)

- © If line 47 is $20,000 or less and you did not average your income on Schedule. G, or figure your tax on Form 2555, Exemption of Income Earned Abroad, find!
your tax in Tax Table. Enter tax on line 16 and check appropriate box.

© If line 47 is more than $20,000, figure your tax on the amount on line 47 by using Tax Rate Schedule X, Y, Z, or if applicable, the alternative tax from Schedule
i ’D, income averaging from Schedule G, tax from Form 2955 or maximum tax from Form 4726. Enter tax on line 16 and check appropriate box.

oa Credits

Credit for the elderly (attach SchedulesR& RP). - 6 ep oe ee tt tts 48
0 Credit for child care expenses (attach Form 2441)
. 50 Investment credit (attach Form 3468)
51 Foreign tax credit (attach Form 1116) .
52 Contributions to candidates for public office credit (see pi page 212 of Instructions) .
_ 53 Work Incentive (WIN) Credit (attach Form 4874) . : er

2

i

}_Total add lines 48 through 53), Enter here and on line 19

Wacsrves! f=4 Other Taxes

55 Tax from recomputing prior-year investment credit (attach Form 4255)
» 56 Minimum tax. - Check here [> [], and attach Form 4625 «.

57 Tax on premature distributions from attached Form 5329, Part Vv.
_ 58 Self émployment tax (attach Schedule SE) ‘ .
59 Social:security tax on tip income not reported to employer (attach Form 4137) .
60 Uncollected employee social security tax on tips (from Forms W-2)' sone
61 Excess contribution tax from attached Form 5329, PartIV. 20. ee ee ee

Total (add | lines 55 through 61). Enter here and on line 21 woe eee
Sess Other Payments +
” .: 63 . Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers—see page 13 of ‘lastructions)
64 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136) .

' 65 Credit from a Regulated Investment Compdny (attach Form 2439) -
-66 Total (add lines 63 through 65). Enter here and on line 23e

.NW 88326 Docid:32245535 Page 6

SE US. GOVERNMENT PRINTING OFFICE : 1976—O-218-052 ve _ 218-0522

OL Tapia deep aagpiceg erpeenemenerereriee rear

RRS Py aia LT

wg
pe

te
in

‘Sched és AsB—Itemized | Deductions AND
‘(Form 1040) a Dividend and Imterest income.

"Department of the, Treasu an > Attach to Form 1040. > See Instructions for Schedules A and B (Form 1040).
1, Name(s) as shown on Form 1040 ;

Schedule A—Itemized Deductions (Schedule B on back)

Contributions (See page 15 of Instructions for examples.)

Medical and Dental Expenses (not compensated by insurance
. ‘or otherwise) (See page 13 of Instructions.)

1 One half (but not more than $150) of in-
surance premiums for medical care. (Be
sure to include in line 10 below)

. 2 Medicine and drugs
3 Enter 1% of line 15c, Form 1040 .
: “4 Subtract line 3 from line 2. Enter differ-
ence (if less than zero, enter zero)
; 5 Enter balance of insurance premiums for
-- medical care not entered on line 1
_ ‘ \i & Enter other medical and dental expenses:
a Doctors, dentists, nurses, etc. ,
_ db Hospitals . te ae
4" -@ Other (itemize—include hearing aids,
dentures, eyeglasses, transportation,

21 a Cash contributions for which you have
receipts, cancelled checks or other
written evidence . . . ee
b Other cash contributions. List donees : :
and amounts. B ____.. 22. 2--2-- eee eee eee | ——

22 Other than ‘cash (see page 15 of instruc:
tions for-required statement) ' .

23 Carryover from prior years . .
24 Total contributions (add lines 21a through / >a
23). Enter here and on line 37... >
| Casualty or Theft Loss(es) (See page 15 of Instructions.)
Note: If you had more than one loss, omit lines 25 through 28
and see page 15 of Instructions for guidance.

25 Loss before insurance reimbursement .
26 Insurance reimbursement .

27 Subtract line 26 from line 25. Enter dif-
ference (if less than zero, enter zero)

28 Enter $100 or amount on line 27, which-

. 7 Total (add lines 4 through 6c)

; 8 Enter 3% of line 15c, Form 1040. ever is smaller. . . - ee es _
- §-Q Subtract line 8 from Sine 7 (if less than | 29 Casualty or theft loss (subtract line 28 @ ce .
zero, enter zero) ]____from line 27). Enter here and ontine 38. | 7 |g

-. 10 Total (add lines 1 and 9), Enter here and
on line 34... > |
., Taxes (See page” 13 of Instructions.) ;

| Miscellaneous Deductions (See page 15 of Instructions.) a

30 Alimony paid
31 Union dues . woe ee Lo
32 Other (itemize) P____.....-.-.-2-22------------ ee

‘11 State and local income... + -
12 Real estate. . - - oe
+," 43 State and local gasoline (cee gas tax tables)
". ; 14 General sates (see sales tax tables)
fs 15 Personal property, . - + + +
“+” 146 Other (itemize) > .

33 Total (add lines 30 through 32). Enter
here and on line 39

34 Total medical and dental—line 10 .

35 Total taxes—line 17 .

36 Total interest—line 20...

37 Total contributions—line 24 .

38 Casualty or theft loss(es)—line 29

39 Tota! miscellaneous—tine 33 .

40 Total deductions (add lines 34 through
39). Enter here and on Form 1040, line

' 20 Total (add lines 18 and 19). Enter here
and on line 36. wee ee we

218-054-1

> NW BB 326. Doctd:32245535 Page f

INW.88326.

Schedules A&B (Form 1040) 1976
Name(s) as shown on Form 1040 (Do not_enter name and social security

Schedule B—Dividend and Interest Income

Page 2

number if shown on other side) ‘Your social a sna 1G)

Dividend Income

+ ee I# gross dividends (including capital-gain distributions) and

’ other distributions on stock are $400 or less, do not complete this
part. But enter gross dividends less the sum of capital gain dls-
tributions and non-taxable distributions, if any, on Form 1040,
line 10a (see note below).

"1 Gross dividends (including capital gain distributions) and other

distributions on stock. (List payers and amounts—write (H),
(W), (J), for'stock held by husband, wife, or jointly)

MELEE EE

2 Total of line 1
3 Capital gain distributions (see page $16 of
Instructions. Enter here and on Schedule D,

line 7). See note below
4 Nontaxable distribu-

tions (see page 16 of
’ Instructions) .

5 Total (add lines 3 and 4)

6 Dividends before exclusion (subtract line
5 from line 2). Enter here and on Form
1040, line 10a

Note: If you received capital @ain distributions and do not need Schedule D to report any other wins or josses or To compute -
the alternative tax, do not file that schedule. Instead, enter 50 percent of capital gain distributions on Form 1040,

line 30b.
Fru, |. Foreign Accounts and Foreign Trusts

3224 iQ
F Interest Income

rest is $400 or Jess, do not complete this part. But
nt of interest received on Form 1040, line 11.

A 8t includes earnings from savings and loan aseaciations,
mutial savings banks, cooperative banks, and credit unions
‘ag wéll as interest on bank deposits, bonds, tax refunds, etc.
Interest also includes original issue discount on bonds and
other evidences of indebtedness (see page 16 of Instructions).
(List payers and amounts)

More Do Oe EY {o
t &:

IIT!

LETT ET EP EPP EE

~

=

t

—_—i

8 Total interest income. Enter here and on
‘Form 1040, line 11

2 Did you, ‘at any time during the taxable year, have any interest in or signature or other authority over a bank,

securities, or other financial account in a foreign country (except in a U.S. military banking facility operated by a

U.S. financial institution)? . . oe 4
. If-“Yes,” attach Form 4683 (For « definitions, see @ Form 4683. )

’ 2 Were you the.grantor of, or transferor to, a foreign trust during any taxable year, which foreign trust was in
being during the current taxable year, whether or not you have any beneficial interest in such trust? .

it.“Yes,” attach Form 4683 (For definitions, see Form 4683.)

vx U.S. GOVERNMENT PRINT!

am Yes/No
Cc] Yes. <2No

ING OFFICE: 1976-—-O-218-054 218-054-1

Docld:34245535..Page8.—

a pre,

7 ae oe eee nee eae

’ Name of proprietor

Income

eS"

Internal Revenue Service b> Attach to Form 1040. © See Instructions for Schedule C (Form 1040).

A Principal business activity (see Schedule C Instryed ions) &.. Sb s ez
B Business name>... LOODPLEy | freee a, ih PEE
D Business address (number and street) B.. le é 2 BS. YES. Tylee 7 es eeseesseetentecees

City, State and ZIP code >. ENCha cod CH 913!
E Indicate method of accounting: (1) [7] Cash (2) Accrual (3) [_] Other >
F Were you required to file Form W-3 or Form 1096 for 1976 (see Schedule C Instructions)? .

If “Yes,” where filed B..

‘G Was an Employer's Quarterly Federal Tax Return, Form 941, filed ‘for this business for any y quarter in 19767 :
’ H Method of inventory valuation >

Was there any substantial al change i in

i

ae

- SCHEDULE. C Profi t or (Loss) From Business or Profession
; 1040) (Sole Proprietorship)
(Form 10 70) wy Partnerships, Joint Ventures, etc., Must File Form 1065. — 1978

the manner of determining quantities, costs, or valuations between the opening and. closing inventories? (If “Yes,” attach explanation) .

1 Gross receipts or sales bare Less: returns and allowances $...............-cee- Balance >
2 Less:.Cost of goods sold and/or operations (Schedule C-1, line 8)
3 Gross profit .
4 Other income (attach schedule) .
5 Total income (add lines 3 and 4)
6 Depreciation (explain in Schedule C3) . .
7. Taxes on business and business property (explain in- Schedule C 2) .
8 Rent on business property :
9 Repairs (explain in Schedule C-2)
10 Salaries and wages not included on line 3, Schedule c-1 (exclude a any ‘paid te to yourself) .
11 Insurance. . . ee
12 Legal and professional fees
13 Commissions . 1
14 Amortization (attach statement) . .
15 (a). Pension and profit- sharing plans (see Schedule Cc instructions)
(b) Employee benefit programs ‘(see Schedule C Instructions)
16. Interest on business indebtedness ‘ ; :
17 Bad debts arising from sales or services
Depletion .
Other business expenses 5 (specify):

Deductions.
=
o

(k). Total other. business expenses (add lines 19(a) through 190)
20 Total deductions (add lines 6 through 19(k)) ..

21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on Form 1040, line 29. ALSO
enter on. Schedule SE, line 5(a) . . . .

1 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation)

2 Purchases $. ... Less: cost of items withdrawn for personal use $..............-.--....- Balance >
3 Cost of labor (do not include salary paid to yourself)

4 Materials :and supplies woe ee toe

5 Other costs (attachschedule) . 2 2. 6 6 6 ee ee ew ee

6 Total of lines through 5 . 6 6 6 ee ee ee ee

7 Less: Inventory at end of year
8 Cost of goods sold and/or operations. Enter here and on : line 2 above

2 Lost of g00ds Sold and/or oper
Did you claim a deduction for expenses of an office in yourhome?. - - - +e 2 2 + oe tot te (] Yes . [] No
a

218-055~1

NW 88326 Docid:32245535 Page 10

Schedule C (Form 1040) 1976 Page 2

SCHEDULE C-—2,.—-Explanation of Lines 7 and 9

Line No. ” Explanation Amount Line No. Explanation Amount

SCHEDULE C-3.—Depreciation (See Schedule C Instructions for Line 6)
If you need more space, use Form 4562.

d. Depreciation e. Method of .
rae b. Date c. Cost or . in f. Life g. Depreciation for
_ @ Description of property acquired | «other basis alt wed allowable | see or rate . this year

1 Total additional first-year depreciation (do not include in items below) ——$—$ $$$ $$$ $$
42 Other depreciation:

3 Totals... ee
4 Less ‘arnount of depreciation claimed in Schedule C-1, page 1
5 Balance—Enter here and on page 1, line 6

SCHEDULE C—4.—Expense Account Information (See Schedule C Instructions for Schedule C—4)

Enter information with regard to yourself and your five Name Exerise account UMA
highest paid- employees. In determining the five highest | Owner . . . . a. tok . Za

paid employees, expense account allowances must be
added to their salaries and wages. However, the informa-
tion need not be submitted for any employee for whom
the combined amount is less-than $25,000, or for your-
self if your expense account allowance plus line 21, page
1, is less than $25,000.

Did you claim a deduction for expenses connected with: . . _. ;
(1) Entertainment facility (boat, resort, ranch, etc)? .. (Yes [J] No (3) Employees’ families at conventions or meetings? . . (J Yes [] No.
; (2) Living acconimodations (except employees on busitiess)? O Yes (1 No (4) Employee or faniily vacations not reported on Form W-2? <C] Yes 1 No.

* U.S. GOVERNMENT PRINTING OFFICE : 1916~0-218-088

218-055~2 :.
3 *

“SCHEDULED | Capital Gains amd] LOSSe@S (Examples of property to be reported on this

(Form 1040) Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but not
‘Department of tho Treasury | losses) on personal assets such as a home or jewelry.)

’ re, ‘intarnal Revenue Service p> Attach to Form 1040. © See Instructions for Schedule D (Form 1040).

: *«: Name(s) as shown on Form 1040 Social security number
\P h van tpi e°
CVA MY 32242-1799 i_f

osses—Assets Held Not More Thay 6 Months

site co . : b. Date e Date @. Cost = ath basis, ¢ 4
: “a. Kind of property and descrition : qui “sold dG f] i aS adjus! (seo f. Gain or (loss)
(Example, 100 shares of ‘'2Z'? Co.) (Mon day ye) (Mo., day, yt.) mas sass Poe instranee of ani (d less @)

o . |. 2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries . . . « « 27
3 Enter net gain or (loss), combine linesland2 . . . . . . (3.
4 — Short-term capital loss carryover attributable to years begining after 1969 (see instruction ) . {4

at . 5 _Net short-term gain or (loss), combine’ lines 3‘and 4 wo. ee ee

7 Capital gain distributions . . . Loe res ee Ae .
- 8 Enter gain, if applicable, from Form 4797, line 4(a)(1) ‘ee Instruction A) rs ie

9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries . . . . . 9

10 ‘Enter your share of net long-term gain from small business corporations (SubchapterS).. . . _10_
‘21° Net gain or (loss), combine lines 6 through 10 © . . » |

12. Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction 1 . 12
‘13 Net long-term gain or (loss), combine lines 1l.and 12. . 13 |
Ree] Summary of Parts | and Il (/f You Have Capital Loss Carryovers From Years Beginning ng

Complete This Part. See Form 4798, Parts Ill, iV and V.)

len

14 Combine lines 5 and 13, and enter the net gain or (loss) here ©. 2 ee ee te 14
15 If line 14 shows a gain— an ed
a Enter 50% of line 13 or 50% of line 14, whichever is smaller (see P Part Vv for computation of
alternative tax). Enter zero if there is a loss ornoentry online 13 . . . . |15a

b Subtract line 15a from line 14, Enter here and on Form 1040, line30a . , . ww ws [5b
- 16, If line 14 shows a loss—-~" i _
rr a Enter one of the following amounts:
: (i) If line 5 is zero or a net gain, enter 50% of Jine 14;
(ii) _ Hf line 13 is zero or a net gain, enter line 14; or,
(ii) Vf line 5 and line 13 are net losses, enter amount on line 5 added to 50% of amount on
an " ; tine soe ee _ oo -
“bp Enter here and enter as a (loss) on Form 1040, line '30a, the smallest of:
(? $1,000 ($500 tema fied’ d fili te ret n);
{i if married and filing a separate re urn); or, .
(iit) Taxable income, as adjusted (see Instruction J). . SEE . VA.


~ n . : é
"+-Schedule D (Form 1040) 1976 - ; . . ” Page 2

FeartlVae [| Computation of Alternative Tax (See Instruction S to See if the Alternative Tax will Benefit You)

17 Enter amount from Form 1040, line47 2. 17) .
. 18, Enter amount from line 15a (or Form 4798, Part Y, line 1)) 18 |
“19 Subtract line 18 from line 17 Cif line 18 exceeds line 17, do not complete | the rest of this s part, The e Alter:
native Tax will not benefit you) 2 6 we 19
Note: If line 18 does not exceed $25, 000 ($12, 500 if married filing separately), omit lines 20 through
23 and enter zero on line'24,
\ .
20 Enter $25,000 ($12,500 if married filing separately) . . . . 20 ___
21 Add fines 19 and 20 2 1 ee ee | BR
_, 22 Taxonamountonlinel7® 2 6 6 22 __
: 23 Tax on amount on line 21*. 6 | 6 ee 23
' 24 Subtract line 23 from line 22. . . . . . ee ee ee ee | 2
’ 25 Taxon amount online 19%. 6. 25
26 Enter 50% of line 18 but not more than $12,500 ($6,250 if married filing separately) . . . . 26 | : :

. . 27 Alternative Tax—add lines 24, 25, and 26. If smaller than the tax figured on the. amount on Form 1040,
tine 47, enter this alternative tax on Form, 1040, line 16. Also check the Schedule D box on Form 1040,
line 16 ee ee we eee 27

pa a ee oe

/ > */f the amount.on which the tax is to be computed is $20,000 or less use the Tax Table; if more than $20,000 use Tax Rate Schedule X, Y, or 2.

eT

| Note: Enter your capital loss carryovers from 1976 to 1977: " \____Pre-1970

Short-term (from Form 4798, Part Il or Part V) .

Long-term (from Form 4798, Part Ii or Part V) .

ae

ORs ’ _ . ‘Sy US. GOVERNMENT PRINTING OFFICE : 1976—O-218-086 218-056-1

Docid:32245535_Page.12..- -


SCHEDULE SE
(Form 1040)

“. + Department of the Treasury
* Internal Revenue Service

Computation of Social Security Self-Employment Tax:

f> Each self-employed person must file a Schedule SE. ff Attach to Form 1040.
> See Instructions for Schedule SE (Form 1040).

. © If you had wages, including tips, of $15,300 or more that were subject to social security or railroad retirement taxes, do not fill in

this schedule (unless you are eligible for the Earned Income Credit). See Instructions.
; . © If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.

Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.
NAME OF SELF-EMPLOYED PERSON (AS_SHOWN ON SOCIAL SECURITY CARD)
Sam Rw B

* Business activities subject to self-employment ta (grocery store, restaurant, farm, etc.) >

© If you have only farm income complete Parts | and Ill, © If you have only nonfarm income complete Parts Il and III.
© If you have both farm and nonfarm income complete Parts |, II, and III. :

- ERIE] Computation of Net Earnings from FARM Self-Employment

Social security number of

self-employed person p>» 22 an ? 4 q

5

You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line
2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600.. However, lines 1 and

2 must be completed even if you elect to use the FARM OPTIONAL METHOD.

\ REGULAR METHOD a Schedule F, line 54 (cash method), or line 72 (accrual method) _la_
1 Net profit or (loss) from: b Farm partnerships . Lo _ib_
2 Net earnings from farm self-employment (add lines laandb). . . . 2 [2

3 If gross profits a Not more than $2,400, enter two-thirds of the gross 5 profits .
from farming * are: b More than $2,400 and the net farm profit is less than $1,600, Enter $1,600
1Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 70 (accrual

method), ‘plus the’ distributive share of gross profits from farm partnerships (Schedule K—1 (Form 1065), line 14)
as explained in instructions for Schedule SE.

4 Enter here and on line 12a, the amount on line 2, or line 3 if you elect the farm optional method .

lelaul....) Computation of Net Earnings from NONFARM Seif-Employment

FARM OPTIONAL METHOD |

a ‘Schedule C, line 21. (Enter combined amount if more than one business.)

Tan ese

1978

. b Partnerships, joint ventures, etc. (other than farming) . . _b_ —_
a, c Service as a minister, member of a religious order, ora Christian Science ‘
REGULAR METHOD | - © practitioner. (include rental value of parsonage or rental allowance fur-
5 Net profit or . nished.) If you filed’ Form 4361, check here > C] and enter. zero on this
(loss) from:. - ‘fine . Soke ek Lo. Lone Lo... [Se
d Service with a ‘foreign government or international organization : _5d_
(See Form 1040 “in- 5e

@ Other’ structions for line 36.) SPECIFY Be ieee eee eeeeeee ce cceeeneec ene eneeenees peo:
(6 Total (add lines 5a through e) .
7 Enter adjustments if any (attach statement)

8 Adjusted net earnings or (loss) from nonfarm self- “employment (line 6, as adjusted by line 2.

- H line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit dines 9

through 11.and enter amount from line 8 on line 12b, Part III,

Note: You may use the nonfarm optional method (line 9 through line 1D only if line 8 is tess than $1,600 and less
than two-thirds of your grass nonfarm profits,= and you had actual net earnings from self-employment of
$400 or more for at least 2 of the 3 following years: 1973, 1974, and 1975, The nonfarm optional method
can only be used for 5 taxable years.

NONFARM OPTIONAL METHOD

9 a Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
b Enter amount from line 3. (lf you did not elect to use the farm optional method, enter zero) .
c Balance (subtract line 9b from line 9a) soe .

10 Enter two-thirds of gross nonfarm profits * or $l, 600, whichever j is smaller .

11 Enter here and on line 12b, the amount on line 9c or line 10, whichever is smalier .
? Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the ‘distribu-
tive share of gross profits from nonfarm partnerships (Schedule K—-1 (Form 1065), line 14) as explained in instruc-
fions for Schedule SE. Also, include gross profits from services reported on line Sc, d, and e, as adjusted
y fine

Computation of Social Security Self-Employment Tax

12 Net earnings or (loss): a From farming (from line 4) .
b From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) .
13 Tota! net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400,
you are not subject to self-employment tax. Do not fill in rest of schedule.) . :
14 The largest-amount of combined wages and self-employment earnings subject to social security or
railroad retirement taxes for 1976 is . see ee
15 a Total “FICA” wages and “RRTA” compensation wee ;
b Unreported tips subject to FICA tax from Form 4137, line 9 or to RRTA .
‘ ce Total of lines 15a andb .
. 16 Balance (subtract line 15c from line 14). :
17 Self-employment income—line 13 or 16, whichever is smaller .

18 Self-employment tax. (If line 17 is $15,300.00, enter $1,208.70; if less, multioy the amount on line
17 by 079.) Enter here and on Form 1040, line 58 . woe : wos

15a
15b_

-NW.88326 Docld:32245535 Page 13.

=z

12a

12b 354 & :

Zz Zz

.

218-060-1

(13 | 3SUh |
00


.

Capital Loss Carryover
(Computations of Capital Loss Carryovers and Summary of Capital
Gains and Losses if Pre-1970 Capital Losses are Carried to 1976.)

Social ny Number

B Attach to Form 1040.

'*- Note: Complete Only =: 1 oH This Form to Cc pute Your Capital Loss Carryover if Your 1975 Schedule D Form 1040), lines
a : 4(a) and 12(a), DO NOT SHOW A LOSS.

7 Post-1969 Capital Loss Carryovers to 1976 (Complete this part if the amount on your 1975 Schedule D
Pd (Form 1040), line 16(a), is larger than the loss deducted on your 1975 Form 1040, tine 29a.)

‘orm
. Department of the Treasury
Internal Revenua Service

. Name(s) as shown on eS —s

Section A.—Short-term Capital Loss Carryover

Enter loss shown on your 1975 Schedule D (Form 1040), line 5; if none, enter zero and ‘grove |

1
Le lines 2 through 6—then goto lne7 .. . . _i __
— 2 Enter gain shown on your 1975 Schedule D (Form 1040), line 13, i that line is ‘blank or shows
_aloss, entera zero... . Ce ee ee eg HB _
3 Reduce any loss on line 1 to the extent of any gain on line Pr a _
4 Enter amount shown on your 1975 Form 1040, line 29a. . 2 1... ee ee le 4 _
5 Enter smaller ofline30r4. 2. 1 1. 1 we, we ee ee ne tk ee _5_ _——_
6 Excess of amount on line 3 over amount on line 5 2. . ge 6 |
7 Note: The amount on line 6 is your short-term capital loss carryover from 1975 to 1976 that is attributable to years beginning
: after 1969. Enter this amount on-your 1976 Schedule D (Form 1040), line. 4. .
Section B.—Long-term Capital Loss Carryover
7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1975 Form 1040, line 292) . |__7 _ _
8 Enter loss from your 1975 Schedule D (Form 1040), line 13; if none, enter zero and ignore lines
Q9through 12. . , . . {8 __
-9 Enter gain shown on your 1975 Schedule D (Form 1040), line 5. If that line is blank or ‘shows .
“a loss, enter a zero re Bee ee _9 —_—
10 Reduce any loss on line 8 to the extent of any gain on line 9 Coe ee ee ee _10_ _
‘, 11 Multiply amount online 7by2..°.~«« er _—
' 12 Excess of amount on line 10 over amount on line m woh oa , rn 12

Note; The- amount on line 12 is your long-term capital loss carryover trom 1975 to ‘1976 that. is attributable to years beginning “
after 1969. Enter this amount on your 1976 Schedule D (Form 1040), line 12. .

AP artiligh Post-1969 Capital Loss Carryovers from 1976 to 1977 (Complete this part if the amount on your 1976 -

pe arie Schedule D (Form 1040), line 16a, is larger than the loss deducted on your 1976 Form 1040, line 30a.)

eo

Section A. —Short- term Capital Loss Carryover

1 Enter loss shown on your 1976 Schedule D (Form 1040), line 5; if nane, enter zero and ignore lines

2 through 6—then gotoline7. . . . Fa Sa
2 Enter gain shown on your 1976 Schedule D (Form 1040), i line ‘1a! If that line is blank or shows a : 7

loss, entera zero. . . Bee te ee ee eee LB

Reduce any loss on Jine 1 to the extent of any gain on line a

Enter amount shown on your 1976 Form 1040, line 30a... ww ww ee ee LA

Enter smaller.ofline30r4 ... 0. 5. Ce ee ee ee BY

Excess of amount on line 3 over amount on line 5 rr , : 6

Note: The amount on line 6 is your short-term capital loss carryover from 1976 - to 1977 ¢ that is attributable to years | beginning ;
after 1969. Enter this amount in the space Provided on page 2 of your 1976 Schedule D (Form 1040). .

uv. Section B.—Long-term Capital Loss Carryover

Line 4 less line 5 (Note: If you ignored lines 2 through-6, enter amount from your 1976 Form 1040, line 30a)
Enter loss:from your 1976 Schedule D (Farm 1040), line 13; if none, enter zero and ignore lines
9 through’ 12 .

9 Enter gain ‘shown on your 1976 Schedule D (Form 1040), 1 dine 5. if that line is blank or shows @
a loss, enter’ a,zero . . .
‘| 40 Reduce aay loss on line 8 to the extent of any gain on line 9.
‘11° Multiply amount on line 7 by 2 . toe
"12 Excess of amount on line 10 over amount on line 11

; ” Note: The amount on line 12 is your long-term capital loss carryover + from 1976 to 1977 1 that is attributable to years beginning
after 1969. Enter this amount in the space provided on page 2 2 of your 1976 Schedule D (Form 1040).

Form 4798 (1976) ©

NW’88326 Docld:32245535 Page 14_


2

Form 4798 (1976)

Page 2

Do Not Complete the Rest of This Form if You Do Not Have a

Instructions oo

A. Who Should File.— : :

If your 1975 Schedule, D (Form. 1040), lines 4(a) and 12(a)
show a loss: (1) use Part’ dil, below, to determine your capital loss
carryover .to 1976; (2) coniplete your 1976 Schedule D (Form 1040),
lines 1 through 13 to report:capital gains and losses for the current year
and any post-1969 capitaltoss carryovers; and (3) complete Part IV
to figure your net capital gain, or (loss) for 1976 and the capital loss
limitation if necessary. Use , Part V to figure capital loss carryover from
1976 to 1977 for pre-1970 lossés or a combination of pre-1970 and post-
1969 losses.

B. Part.V, Line 19 or 33.—If there is a gain and a loss on the lines
mentioned in the instructions for Part IV, fine 19 or 33, enter the gain
reduced by the amount of the loss. If the loss exceeds the gain enter
a zero. If there is a gain and no loss, just enter the gain.

Pre-1970 Capital Loss Carryover to 1976 (See Instruction A).

t

C. Part IV, Line 22 or 36.—-{f there is a loss and a gain on the lines
mentioned in the instructions for Part IV, line 22 or 36, enter the loss
reduced by the amount of the gain. If the gain exceeds the loss enter
a zero. If there is a loss and no gain, just enter the loss. ~

D. Married Taxpayers Filing Separate Returns.—If you are married
and filing a separate return the limitation for Part iV, lines 9(b)(li)
and 27(b) is $500, increased by amounts attributable to pre-1970 short-
term capital loss components, but the combined total may not exceed
$1,000. If there is a loss in Part IV, line 2, complete Part IV, Section
E. If there is a loss in Part WV, line 5, complete Part IV, Section D,
lines 14 through 22 (assuming all the lines in Section D were not other:

.wise required to be completed) ignoring the note under line 14.

E. Additional information—For information about capital assets,
investment interest expense deduction adjustment, aiternative tax, ete.,
see the Instructions for Schedule D (Form 1040).

Pre-1970 and Post-1969 Capital Loss Carryovers to 1976
Sem] 1975 Schedule D (Form 1040), line 16(a) or line 33,

Form 1040, line 29a.)

1 Enter loss shown on your 1975 Schedule D (Form 1040), iine i if none, enter zero and ignore

lines 2 through 20—then go to line 21 .

2 Enter gain shown on your 1975 Schedule D (Form 1040), line 3. If F that line is is blank or shows a loss enter a zero .

3 Reduce loss on line 1 to the extent of any gain on line 2.

Note: /f line 4(a) on your 1975 Schedule D (Form 1040) is blank, IGNORE lines. 4 through LL, enter

a zero on line 12—then go to line 13.

4 Combine lines 3 and 11 on your 1975 Schedule D (Form 1040).

Enter: the gain; if zero or a ‘loss, enter a zero.

Note: If line 4 is zero IGNORE lines 5 through i, enter on line. 13
, the loss from your 1975 Schedule D (Form 1040), line 4(a)—
“then go to line 13.

$5, Enter any gain from your 1975 Schedule D (Form 1040), line3. .

‘6 Enter smaller of line 4or5.
7 Enter excess of gain on line 4 over line € 6

’ 8 Enter-loss from your 1975 Schedule ie) > (Form 1040), line 12(a):

otherwise, enter a zero... soe
9 Reduce any gain on line 7 to the extent of any loss on n line 8
10 Enter loss from your 1975, Schedule D (Form 1040), line 4(a); other-
wise enter.a zero. . . See ee NN
11 Add the gains on lines 6 and 9.
12 Reduce the loss on line 10 to the extent of any gain on n line ll.

‘13 Pre-1970 short-term capital loss (Enter smaller of line 3 or 12).
"14 Short-term capital loss attributable to years beginning after 1969 (excess of line 3 over ‘tine 1:

15 Enter : ‘any loss from line 13, above .oG
16 Enter loss deducted on your 1975 Form 1040, jline 29a. oe

17 Pre-1970 short-term loss carrygver to 1976 (excess of line 15 over line 16—if line 15 does not

exceed line 16, enter zero). Enter here and in Part NV, ine 2.

18 Enter any loss from line 14, above

19 Enter excess of line 16 over line 15—if line 16 dots n not exceed line
15, enter zero .

20 Post-1969 short-term loss carryover to 1976 (excess of line 18 over line 19—if line 18 does not
exceed line 19, enter zero). Enter here and on your 1976 Schedule D (Form 1040), line 4

iy

if you. were required to complete Part IV of your'1975 Schedule D

(Form 1040), enter any*loss from your 1975 Schedule D (Form

1040), line 30; otherwise, enter %ero.. «

22 Enter excess of line-19 over line 18—if line 19 does not exceed line
18, enter zero. (Note: If you, ignored lines 2 through 20 above, enter

amount from your 1975 Form 1040, line 29a). .

23 Pre-1970 long-term loss carryover to 1976 (excess of line a1 over line 22—if line 21 does not

exceed line 22, enter zero). Enter here and in Part IV, line 5

24 If you wete required to complete Part IV of your 1975 Schedule D

(Form 1040), enter any loss from your 1975 Schedule D (Form
1040), tine 31. However, if Part IV was not required, enter any loss
from your 1975 Schedule D (Form 1040), line 13. ~«

Enter excess of line 22 over line 21 ..

25 Enter excess of line 22 over line 21 .........!
does not.exceed line 21, enter zero.) ’.

a

26 Post-1969 long-term loss carryover to 1976 (excess | of line 24 over line 25—if line 24 does not
exceed line 25, enter zero). Enter here and on your 1976 Schedule D (Form 1040), line 12

w'W.88326 Docld:32245535 Page 15 _.

x 2 at line 22

(Complete this part if-the amount on your
is larger than the loss deducted on your 1975

4/5105) _

ee GOO

—S_
_8_
7
—8_
9
10
il =

15
16

So

a] &2I7)
22 A

2 | SEZF |
25 | o-,


Bory
and Losses

- te

Section A.—Short:term Capital Gains’

Amount from (1976. Schedule D (Form 1040),
Amount from Part Ill, tine 17. yee,
; Net short-term gain or (joss), combine ines 1 and 2.

ine 5,

Section B.—Long:term Capital Gains and Losses

| 1976 Schedule D (Form 1040), line 13.
. Artount from ‘Part Ml, tine 23. rn
‘6 Net long-term gain or (loss), combine lines 4 and 5

‘

Section C.—Summary of Sections A and B

‘ .

“Combine tines 3 and 6 and enter the net ain or (loss) here.

8 If line 7 shows a gain—

(a) Enter 50% ‘of line 6 or 50%
a

of line 7, whichever is smaller (see Schedule D
rnative tax), Enter zero if ther
jline 8(a) from tine 7. Enter h

(Form 1040), Part
@ is a loss or no entry on line 6
€re and on Form 1040, line 30a

therwise,... ae
a) Enter one of the following amounts:
43,1) + tf line 3 is zerd oF a net gain, enter 50% of line 7;
(ii) If line 6 is zero-or a net gain, enter amount from line
(iii) If tine-3 and line 6 are net losses, enter amount
“on-line 6 2. Cr or Por,
“(b) Enter‘hére ‘and enter as a (loss) on Form 1040, line 30a; the smallest of:
-(i) The amount on line. 9(a); : . : tet .
hi) $1,000 (married taxpayers filing separate returns see Instruction D); or
(iii) Taxable income, as adjusted (see Instruction J in ‘Instructions for Schedule D (Form

nd 6, omit lines 9(a) and (b) and go’ to Section D.

7; or
on line 3iadded to 50%

of amount

1040)). |,

9(a)

i)

o Section D.—Capital Loss Limitation—Where Losses Are Shown on Both Lines 5 AN

0 ‘Enter loss from line 3; if line 3 is zero ora
¥ . fae
F loss from,tine 6

gain, enter a zero.

m if line 3 is zero or a Joss, enter a zero Loe
rf line! 11 to the extent of the gain, if any, on tine 12 .

biné amounts on 1976 Schedule D (Form 104 ih
‘if gain, enter gain, if zero or a loss, enter a zer at

0), lines 3 and

0 Lot 14
Note: if the entry on line 14 is zero, OMIT lines 15 through 21 and ia
i’. . enter on line 22 ihe loss shown on line 5. . , Bs
15,Enter gain,-if any; from 1976 Schedule D (Form 1040), line 11 15
Enter smailer. of amount on line 14 or line 15... , 16
; Enteréxcess of gain-on line 14 over amount on line 16 17
8 Enter loss from ‘tine.2: if line 2 is blank, enter a zero 18

on line 17 to the extent of loss, if. any, on line 18 {se

. 19
es... 20
1 Add the gain(s) dn line(s) 16 and 19: 21

‘on line 21 (see Instructio

24‘ Subtract amount on jine 23 from the loss on line 13.

25 ‘Enter 50% of the amount on line 24

26 “Add lines 10, 23, and 25 |

27. Ent

“here-and enter‘as'a (loss) on Form.1040;
‘Amount.on line 26;". ‘

$1,000 (Married t
¢) Taxable income, 2

line 30a, the smallest of: .
ae ~

ax

Payers filing separate returns see Instruction D): or ‘
S adjusted (see Instruction J in Instructions for Schedu

(Form 1040)) .


: MEDICAL.

ce

CALENDAR YEAR __ feo

SOC. SEC. NO. 322-12 7944

DEDUCTION SCHEDULE

FEDERAL

ZINCOME TAX PREPARATION _ |

[State | FEDERAL CONTRIBUTIONS —¢ | —SSTATE
2 MEDICINE/DRUGS’_. | t...._ | [2tacasncontaisutions \J S| |
SLESSI% AGI (Line 18-104) | | | dE 2 tb PARTNERSHIP SHARE Ye ee)
““QNET MED/DRUGS {|_| [| Gaveoyscours RT
5H & A INS. (4 + EXCESS) |_| ¥Os. | [| veartrunoicancenruno{\ || FO
fa DR. | [TY] eocrossjunitenruno ff TT
OR. NL xwasvenstensears = 7 TT
DR. NE isc orcanizep cuaritiesf TT
“oR. | LD rotiticacconrarutions Jo TT
val DR. Jf. OTT crurcues
DR. | [fT pe
‘OR. SN es NY (OO GO
DR. ES RN NN NS ORNs (SN SU SS
an Y.-C otner tHancash TCO
Gb HOSPITAL Y. |... |__[24toratcontrsutions bE go | PO
PROSTHETIC APPLIANCES | [CASUALTY OR THEFT (LOSS(ES)
HEARING AID: |} “J toss meron asin
Gt AMBULANCE NS A £2 OO
“LABORATORIES TOSCO SSB isto Limitation rercas.) | |
TRAVELFORMED./ OED || dL SOL, [29 ror. cas. on tHertioss LS
: CUT CT MISCELLANEOUS DEDUCTIONS _ a _
~ MEDICARE INS. FMT TC 8D atimony
GLASSES TCM CC [3 unionsproressionat pues _|
[3ZINCOME TAX PREPARATION _|

7 MEDICAL EXPENSES
LESS REIMBURSED BY INS.

8 LESS 3% ADJ. GROSS INC.

I+:% (TO $150) OF H & A INS.
40 TOTAL MEDICAL DED.
: TAXES ;
—ILSTATE & LOCAL INCOME .
“AZREALESTATE

13 STATE & LOCAL GASOLINE

14 GENERAL SALES TAX

18a PERSONAL PROPERTY
' {5b PERSONAL PROPERTY AUTO
~ 16 SALES TAX AUTO .

: 17 TOTAL TAXES
- INTEREST (TO WHOM PAID
18 MORTGAGE

co

49 INSTALLMENT

re

LOANS

we

90 TOTAL INTEREST ~:

' N88826.Bioeld:32245536~Rage.t t=

is
‘
Ne

i (erie DEDUCTIBLE MEDICAL & DENTAL |
EXPENSES (FROM LINE

5 TOTAL TAXES (From Line 17)
6G TOTAL INTEREST (Line 20)
7 TOTAL CONTR. (Line 24)

138 CAS. & THEFT LOSS{ES) (Line 29

TOTAL MISCELLANEOUS
DEDUCTIONS (FROM LINE 33)

a
X
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Ser

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TOTAL ITEMIZED DEDUCTIONS T
ENTER ON FORM 1040 LINE 44

EMARKS

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1.0. NO. . , CALENDAR YEAR 19 Th.
OR? +) 99-735 " —
Soc. SEC. NO; deed 22 -I2.>F49Q

roe 34g

FISCAL YEAR ENDING _.

SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION
"PRINCIPAL BUSINESS ACTIVITY j j j
BUSINESS NAME . ; EMPLOYERS NO.

Se

|BUSINESS ADDRESS ‘ -
“TOTAL RECEIPTS

f TNVENTORY AT BEGINNING OF YEAR
“MERCHANDISE PURCHASED
LABOR '. :

TOTAL; a
“INVENTORY AT END OF YEAR

Vo" GROSS PROFIT:

“GROSS INCOME

™
‘ . oa

an “ ce OTHER BUSINESS DEDUCTIONS
" "ADVERTISING :
“AUTO AND TRUCK EXPENSE

BAD DEBTS

“ CASH SHORT . >
V1". COMMISS LONS

DEUWVERY ©
~ DEPRECIATION’ ( SCHEDULE ATTACHED }
DUES AND SUBSCRIPTIONS “wae

‘ENTERTAINMENT AND PROMOTIONAL
INSURANCE

. “INTEREST

pe JANITOR SERVICE

. LAUNDRY
**LEGAL AND ACCOUNTING

MAINTENANCE

‘

OFFICE SUPPLIES: AND EXPENSE

. RENT
"REPAIRS ©

oar < :

ror - SALARIES AND WAGES

SALARIES OFFICERS

ol, SUPPLIES +, ; ;
a a

a “TAXES AND LICENSES

1

TAXES - PAYROLL

“TELEPHONE

Y TRAVEL

‘ye CUTILITEES

: . wt
4 : 3

(NET, PROFIT:-OR( LOSS ) - FEDERAL RETURN

“NET PROFIT OR LOSS ) + STATE RETURN ( SEE DEPREC, SCHEDULE FOR DIFF. )

Pye ’

| : sy .
“ PROFESSIONAL STATIONERS INC. FORM 104 .
wit LOS ANGELES, CALIF. SCHEDULE

"NW B8426 Docld:32245535 Page 18.


sd : 1.D._NO.. CALENDAR YEAR 19 LZke

| _ oR 0b 2242 IY Deis

‘ ADDRESS : . 2: soc. SEC. N DP FISCAL YEAR ENDING ;
: . 19

“ SCHEDULE .OF DEPRECIATION / AMORTIZATION

° SPEC 20% P RATE(®) | DEPRECIATION
KIND OF PROPERTY “pep } OR LIFE _ FOR
fF (YRS) THIS YEAR

°
m 7
°
2
m
5:
>
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72
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iW'88326 Bocld:32245535 Page 19

| ai
'

TOTALS i
i )
; . : Add 20% Additional Depreciation on Items Purchased THIS Year. [. |
ae oe oo, ~~ TOTAL DEPRECIATION Tuls YEAR | 7O4 |
PROFESS 1OWAL STATIONERS INC. hos. ANGELES 2 CALIF. FORM no torn Lo ee _ a = i - a 7 oo scneouce : an a ~ . = Ss

Re a a

wer
19

vite 4 3 ku B Fai 47 “Calendar Ye

SOC. SEC, NO. 322 E/Y/E

GAINS ON INSTALLMENT SALES

Et oP _
‘a DATE solo Gf x7 a

CAPITAL “SEC. “eas

“NOTES oT YR

MORTGAGE TRANSFERRED

PRIOR TO 1—1-62
_ PRIOR’ TOA 1-64". -

EXCESS OVER S/L 1—64/12—-69

, EXCESS OVER S/L AFTER 12-31-69
M4 ADJUSTED BASIS (6-7 THRU 13)

"45." EXPENSES OF SALE’

16. TOTAL ADJUSTED BASIS (14 + 15)
7.-TOTAL GROSS PROFIT (5 — 16)

8. TOTAL GROSS.PROFIT — ORDINARY
AQ. TOTAL GROSS: ‘PROFIT — OTHER

20. CONTRACT, PRICE. (b4+24+ 4)

“CASH (1)
+, PRINCIPAL’ COLLECTIONS
“EXCESS MORTGAGE.OVER BASIS
“OTHER (4) =:

““TOTAL: PAYMENTS (23 THRU 26)
‘RECOGNIZED GAIN Be RO eae eo a

29::, RECOGNIZED’ GAIN ~ ORDINARY 23/3 |
20. ‘RECOGNIZED GAIN — OTHER i 106) 2)
: ORDINARY INCOME - :
“TaKe "TOTAL LESS INT. SECTION 1245 _ 3ECTION 1250 CAPITAL GAIN

* (TO PT. 2
Ae PAYMENTS) | [[0.PT: 2-1 REPORTED BALANCE REPORTED BALANCE REPORTED |: . BALANCE

‘| 26 = ae Tie ; . | an

SO DSEIRLIUSASHSS “PraerDTy CAI ome SCHEDULE


INDIVIDUAL

CALIFORNIA

INCOME TAX

PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) "| Sheek Ag Calendar Year
. Enter social security number(s) only” if incorrect or not shown on label, One: Oo Fiscal Year Ending—______1977

"FOR "PRIVACY NOTIFICATION
SEE PAGE 2 OF INSTRUCTIONS

Your Social Security Number,

Spoyse’s Social Security Number A
tg an * :
; | f AYR ke
occu. | Yours
PATION Spouse's

6 Personal j If line Lo or 3 ‘checked, enter $25 t
If line 2, 4 or 5 checked, enter $50 §
1 7 Dependents —

Do not list the person who qualifies you as head of household
[ae | home

CHorer s

4 © Head of Household—Enter name of qualifying
. individual

ik o Widowler) with dependent child (Year spouse died 197_.}

#8 Blind (see instructions) Number of blind exemptions —_______. X $8
19 Total exemption credits (add lines 6, 7 and 8) Enter here and on v line 20 f
"10 Wages, salaries, tips and other employee compensation attach copy 2 of for ms) W.2 to face of fis}

11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
12. Interest. Enter total (if over $400, complete and attach Schedule B(540) )

13 Income other than wages, dividends and interest (from line 48)

14 Total (add lines 10, 11, 12 and 13)

15 Adjustments to income (from line 55)

16 Adjusted gross income {subtract line 15 from line 1)

i
thong aaah LT SERRE Sa Ve a at

© ff you do NOT ‘itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on’ line 19.
© If you itemize deductions OR tine 16 is $15,000 or more, complete lines 17 and 18.

w “Deductions: . Itemized (from line 63) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 or 5 checked)
“18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on line 19

<d ATTACH COPY 2 OF FORM W-2 HERE D>

“19 Tax from (check one) a Tax Table ax Rate Schedule C] Income Averaging Schedule (G or G-l) .
20 Total exemption credits (from line 9, above) .

21° Tax liability (subtract line 20. from line 19—if line 20 is greater ‘than line 19, enter ser)

22 Other credits (from line 68—\ncluding Special! Low Income Tax Credit) . .

23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter 2210) rn
“o4- Other taxes (from line 71). 0 ee Se ae

25 Total tax liability (add lines 23 and 24) . Fe
96 Total California income tax withheld (attach W-2 or W-2P to face of this return) . . . . . B26 1.
27 Renter's credit—if you lived in rented property on March 1, 1976, complete Part.1 on page 2 ...0927
28 1976 California estimated tax payments © 2 2 1 6 ee ee ee es . ) 28
29 Excess California SDI tax withheld (see instructions). 6 ef ee ee ee ee ee OY
30 TotalCredits.:......... See ke
31 If fine 25 is farger than line 30, enter BALANCE DUE. If it is equal to-line 30; enter zero. oda lao~ |
. Mail return to: : FRANCHISE TAX BOARD : PAY IN FULL — 31 | ao OG
. SACRAMENTO, CA 95867 . Do not write in p these spaces
32 If line 25 is smaller than line 30, enter amount OVERPAID rr 174 om P
-33 Amount of line 32 to be REFUNDED 10 You: anna at least six weeks. :

Mail return to: NCHISE TAX BOARD -_ [7 33
: a BOX 13-540.
SACRAMENTO, CA 95813

34 Amount of line ‘32 to be credited on your 1977 ESTIMATED TAX . i:

a you do NOT want State income tax forms and instructions mailed to you next year, check here Cc] Seé Instructions, Page 9°

o “Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to sbéSt of my knowledge
and belief it is true,:correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Write net eye check or money order. ATTACH HERE >

. . ann
SIGN ere signature ~ Date . . > iaaers sipnature (other, than saxpay a Date

HERE Roernsamaanae Page? return Date - Address’ (and Zip wae"

=
=

Paye 2 Form 540 (1976)

O Yes “yilo If no, you may not claim this credit
OD Yés No If yes, you may not claim this credit
O Yes ONo™ If yes, you may not claim this credit

a 38 Did you or your spouse claim the homeowners’ property ‘tax exemation or receive public assistance? O Yes GNo_ If yes, see page 3 of instructions

PART Il - Other Income

39 Business income (or. loss) (attach Schedule C(540)) . . De ee Cee
. 40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule D540). 2 ee SC ee
At Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-. 1(540))

42.Pensions and annuities . . Se eee ee ee ee
43 Rents and royalties .... cuenuie Le bo

; an SCHEDULE E
44 Partnerships ©. 2... Foam (640) [tcc pets
| 45 Estates and trusts’... . Co 0 | 45
:46-Farm income (or loss) (attach Schedule F(540)). 2. 2 ee ee ee see Se eee ee O

47 Miscellaneous income
(a) Fully taxable pensions and annuities (not reported on Schedute E(540))
(b) Alimony 2... ee ee ee
. (c) Other (state nature and source) — -
; os Enter total of lines 47(a), 47(b), and 47(c) . . See ee en
"48 Total (add lines 39 thru 47). Enter here and on line 13... ee ee ee ee bo ee ee

PART il ~ Adjustments to Income

"49° “Sick pay,” if ineluded in tine 10 (see instructions - attach Form FTB 3805T) .... 2... ee ee /. 8 ceeenteee. en
* §0 Moving expenses (see instructions - attach Form FTB 3805U) Le
“s 51 Employee business expenses, (See instructions - attach Form FTB 3805N) | :
52 Military exclusion (see instructions ) tee Po ee . Be Le
2 53(a) Payments to an individual retirement arrangement (attach FTB 3805P) ee eee : wee (988 ee pepe
(b) Payments to a Keogh (H.R. 10) retirement plan rn i 2 2 eee ereeeeren Bee
(c) Payments to.a self. -employed ‘‘Defined Benefit Plan’’
Enter total of lines.53(a), 53(b), and 53(c |

54 Forfeited interest penalty (see instructions). Le ee . Ce

"55 Total adjustments fadd lines 49 thru 54). Enterhereandonlinel5 ..... 2.0... ee bo ee

. PART IV ~ Itemized Deductions

. o. Attach Schedule A(540) and enter.sub-totals on lines 56 thru 62, below
. 56 Total deductible medical and dental expenses (from Schedule A(540), line 10)
57 Total taxes (from Schedule A(540), line 17)... ee be eee
. 58: Total interest expense (from Schedule A(540), line 20) -- ee ee ee ee
59 Total contributions (from Schedule A(540), line 24)... 0... 2... 2G Pe ee
: 60 Total casualty loss (from Schedule A(540), line 29). Bee eee
_61' Tota! miscellaneous deductions (from Schedule A(540), line 33)... 2 eee ar rn
62 ‘Total child care and adoption expenses (from Schedule A(540), line 37). 2... 0. ee eee :
‘ §3 Total itemized deductions (add lines 56 thru 62). Enter here and on line 17. . Dee be ee

PART V ~ Other Credits: - SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW

64 **Other State’’ net income tax credit (attach copy of other state return and Schedule S(540)). 2. ee ee O64 Joe. beegeecesteseedeceeeeee
_ 65° Retirement income credit (attach Schedule R(540)) 2 6. (©) 65 :
66 Special low income tax credit (see special instructions)... ..... rn rr @) 66 en nee

a Solar energy tax credit (see special instructions). ...........0.5 te ee @) 67 .
68 TOTAL (add lines 64 thru 67). Enter here and on tine 22 68 ;

4 an NS

“PART VI — Other Taxes

70 Tax on premature ‘distributions from attached Form FTB 3805P : .
"TL. Total (add lines 69 and 70) enter here and on tine 240 6 ee ee,

4

_NW 88326 Docld;32245535 Page 22, esas a ee a


FORM 340_

Name as shown on Form 540

- Medical and dental expenses (not compensated by Insurance or otherwise) for
medicine and drugs, doctors, dentists, nurses,
an hospital care, insurance premiums for medical
‘ * care, etc.

“1. One half (but not more than $150) of Insurance
premiums for medical care...................005

2. Medicine and drugs.................. Deve bene
"3. Enter 1% of line 16, Form 540.............0000 eee

‘4 Subtract line 3 from line 2. Enter difference (if less
" than zero, enter Zer0).. 0.0... eee ee eee

< §, Enter balance of insurance premiums for medical care

“+. mot entered on fine 1.................0. bees
“" @. Other medical and dental expenses: ;

* {a) Doctors, dentists,. nurses, So

(b) Hospitals: ,

 (c) Other (itemize)...

 Total—tAdd lines 4, 5, 6a, b, and)...

. Enter 3% of line 16, Form 540..................

9. Subtract line 8 from line 7. Enter difference (if less
than zero, enter zero)... 0000... 62... eee eee

10. Total—{Add lines 1 and 9. Enter here and on Form
540, line 56)... .. Meee ceed eee e eee e ence es

oOo =.

’ Taxes -
11. Auto license—Excess cof registration and Weight fees
(see instructions). “0°... 2.0.0)...
12. Real estate... ccc cece eee es
13, State and local gasoline........ lege cee e eee e en ens
14, General Sales... 22.00... 200 ccc e ee eee
15. Personal property (Boat and Aircraft)..............
16. Other (itemize)...

17. Total taxes—(Add lines 11 thru 16. Enter here and
on Form 540, line 57) .......0.... 00 cere eee

Tk

Interest Expense

18. Home mortgage... 2.0... bvee ee tetees
19. Other (itemize)... =:

26. Total—(Add lines 18 and 19. Enter here and on
Form 540, tine 58).............. 2000s eee es

tes
ran

“NW 88326 Docld:32245535 Page 23

GALIFORWIA

ITEMIZED DEDUCTIONS

Attach to Form 540

USE ONLY IF YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION

Contributions
21(a). Cash contributions for which you have receipts,
canceled checks, etc.
(b). Other cash contributions. List donees and
amounts --

22. Other than cash——See instructions for required state. .
ment

23. Carryover from 1974 & subsequent years — See
instructions 6.00 nee es

24, Tota— (Add-lines 21a thru 23. Maximum de-
duction may not exceed 20% of adjusted gross
income. Enter here and on Form 540, line 59)..... .

Casualty or Theft Loss(es)
NOTE: If you had more than one loss, omit lines 25.
through 28—-See instructions for guidance

25. Loss before insurance reimbursement ..,...--- oe
26. Insurance reimbursement...........0......-0004 -
27. Subtract line 26 from line 25, Enter difference
(If less than zero, enter zero) ... Docc enw teens
28. Enter $100 or amount on line 27, whichever is
" gmaller. cc. eee :
29. Casualty or theft loss (subtract line 28 from
jine 27. Enter here and on Form 540, line 60)

Miscetlaneous Deductions .

30. Alimony paid to: ......--.ere cece eee eeeeegereee
31. Employment Education Expense.
32. Union dues

Other (itemize) ...

33. Total (Add tines 30 through 32. Enter here and _
on Form 540, line 61) . 5; A

Child Care and Adoption Expense 1,
34. Child care expenses ~- Attach Form 3805X. . . . ef.

35. Total adoption expense... - - [| we

Less 3% of line 16, Form 540. -
36. Net adoption expenses —See instructions

for maximum limitations... .....- anes
37. Total child care and adoption expenses

(add liries 34 and 36. Enter here and on : 4

Form 540, line62).. 6... ee ee ee eee .

cenacaeee TT eal

‘" : t we

GALIFORNIE ee

- DIVIDEND AND INTEREST INCOME

Attach to Form 540

[FORM 840 _|

Name as shown on Form 540 - _ Social Security Numba
_ Rury | pe9e)
PART i-—BiVIDEND INCOME
. Line 1—Gross Dividends and Other Distributions on tions), less nontaxable portion, if any, on Form 540, page |.
Steck—if gross dividends and other distributions (including capital Do NOT deduct the $100 federal exclusion.

“Capital gain dividends” are treated as ordinary dividends for
State income tax purposes and not os capital gains as permitted

gain, dividends) on stock were $400 or fess, do not complete
‘this part; but enter gross dividends (including capital gain distribu- under the federal law.

2. Total dividends . .°. a
3. Nontaxable distributions -. Ce
‘4 Taxable dividends—Subtract line 3 from line 2. Enter here and on line 11, form 540 2. . 2) 1 we ee ee
PART li-—-INTEREST INCOME ;
Interest on bonds, -debentures, loans, notes, tax refunds and all (b) Bonds (but not other. obligations) of California and its polit-
types of savings accounts including banks, credit unions and postal ical subdivisions issued after November 4, ‘1902.
_ savings is taxable. : : (c) Interest on bonds of Alaska and Hawaii issued. prior to their
* “Interest on the following obligations is exempt from tax: ,achieving statehood. ‘
‘ (a) Bonds and other obligations (other than tax refunds) of the . -
|. + United States, the District of Columbia and territories of |. Note: If total taxable interest income was $400 or less, do
the United States. (Interest on Philippine Islands obligations not complete this part; but enter the total amount of interest
issued on or after March 24, 1934 is not exempt.) received on Form 540, page 1.

-_ 2»

2. Total Interest Income. Enter here and on line 12, Form 540 . . _ Ce .

NW 88326 Docld:32245535. Page 24


~ PROFIT (OR Lass) FROM BUSINESS OR PROFESSION

(Sole Proprictorships)

‘ Astach this schodule to your income tax retern, Form 340 or S540N2 — Partnorships, Joint ventures, ote, must filo on Form 368

Social PD: Number .
97)

Name as shown on Form 540 or S4NR lL
RA

A. Name and Address of Business ' oe . i . B. Federal mak No.
Dooplty BisTRo CoFr?s “HD? [0 Rrrnilgep Ip Aenedh, ZS = Ze 275"

C. Principal bus fness activity (ie., retail-hardware; wholesale-tobacco; services-legal; ete.)_ $2.2

D. Indicate method of accounting: CO cash; peacerual; O other

E. Were Forms 591, 592, 596 and 599, for ie year filed (if required)? YES. oO No

F. Method of inventory valuation > _.. Dace ceecceeeenaenesemeneneneene eee i aneopeg netesneneee eee peemestenrcccecsenmeecncapanagaeenename atta

_. Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

; DYES (NO If.“Yes,” attach ‘explanation. he

4 Gross receipts, sales, or fees $._____. Less returns and allowances $.. cece mannan encsenn j - Balance &

2 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) ne

3 Purchases $........._---------Less cost of items withdrawn for personal use $....
"4 Cost of labor (do ‘not include salary paid to yourself) a
§ Materials and supplies....0.......-20-002 0. 000ce cece teeter te retro es

6 Other costs (explain in Schedule C-2 or attach, Schedule)... ...... eee eee | CCCs
(7 Total: of fines 2 thd 6... ET

8 Inventory at end of this year :
~ 9 Cost of goods sold (subtract line 8 ‘from line 1) wees vo geneveees _— cp eee centre ees bene cnn nee Lecce tenes
10 Gross profit (subtract line 9 from line ).
11 Other income (attach schedule)....... .. pee . :
1 "Total Income (add lines 10 and 1)... cece eg vee ee pee eter te re voveeee:
‘ OTHER BUSINESS DEDUCTIONS
1 Depreciation lexplain i in 7 Schedule C-1 or attach Schedule)... 0.00.02. 2 eee eee [ tC—C‘i‘Cstisizr :
14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule). eect ence eens

_ 15. Rent on business property...............-0--ge seers re Dope t eee e eterna n eee nnae [CY

- 16 Repairs (explain in Schedule C-2 or attach Schedule). beet e pe pee b ete e een ees eee 6?)
: 17 Salaries and wages not included on line 4 (exclude any paid to yourself). ..........-.. 0. e ee eer eee a
"$B Insurance 0.00 eee etree ers geese etter ices PT
* 19 Legal and profesional fees......... pepe e teense Levee ees cee, ee bee

20 Commissions ........ ll eeceeeeees vegeeies re re ccecceuncenvaes eee [ C—sdCY a

21 Amortization (attach statement)....0.......eeccee eee Meccan ees bees tee b tender eee e tenes Segue LCs

22. Retirement plans, etc. (other than your share, see instructions) cnet ey - Cv bev te eeveees Tr C—CS
/ 23 Interest on business indebtedness. . Lecce betes tee eerste tense e ee eee ecb e eee acces gee eens ‘ on ee

24 Bad debts arising from sales or services (Not applicable if reporting 0 on all, davis) vb env cctv ent eyvees TY

25 Depletion: (attach schedule) : TT _

28 Other business expenses (explain in Schedule C-2 or attach Schedule) ober beg pe eset eeeeee . °

27 Total of lines 13 thu 26.00.2222... ees etter ttt pages cree

2B Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or 540NR....... Le a ao a; ee | Scull

Group and guideline class Date Cost or Depreciation Method of Life or Depreciation
allowed (or allowable) computing ;
_ or description of property Acquired other basis in prior years depreciation Rate for this year

“Schedule C-1
Depreciation
Claimed on line 13.

WWE EXPLANATION ‘amount © HINE EXPLANATION _ | AMOUNT

14, 16, and 26

; Schedule c2 _

Explanation of Lines

NOPBSEZE Docid:32245535 Page 25 SCHEDULE F ON REVERSE


Led CAPITAL GAINS AND LOSSES

‘Name as shown on Form 540 or 540N8

PART I—Assets Held One Your or Lass

2. Enter gain (or loss), if applicable, from fine 17, Schedule D- 1 (540) (attach copy) . , —
3. Enter your share of net gain or loss from partnerships and fiduciaries .
. 4, Net gain or loss, combine lines 1, 2 and 3

“gt

Attach to Form 540 or 540NR

" Use this schedule to report gains and losses on stocks, bonds and similar investments,
ond gains (but not losses) on personal assets such os a home or jewelry.

we

2. Cost or other basis as
adjusted, cost of subse- .
quent improverents (If f. Gain or loss:
not purchased, attach (d. fess 2.)
exlanation) and a

penta of sao

¢. Date sotd
(ms., day, yr.)

. d. Gress sales
price

b. Date acquired
(mo, day, yr.)

a. Kind of property and description
(Example, 100 shares of ‘‘Z" Co.)

6. Enter gain (or loss), if ‘applicable, from line 19, Schedule D-1 (540) (attach copy) .
7. Enter your share of net gain or loss from ‘partnerships and fiduciaries .
8. Net gain or loss, combine lines 5, 6 and 7 (if gain, see 540 instructions, line 24a “Preference tncome))

10.
V1.
12.

- PART fil—Assets Hold Mere Than Five Years

Enter ¢ gain (or joss), if applicable, from line 21, Schedule D-1 (540) (attach copy)
Enter your share of net gain or loss from partnerships and fiduciaries . an
Net gain or loss, combine lines 9, 10 and 11 (If gain, see 540 instructions, line 24a (Preference  Income))

. PART {¥—Summary of Capital Gains and Losses

13.
14,
oars
16.
17..,
18."
19.

- (b) the taxable income. for the toxable year. (computed without regard to gains or losses from sale or exchange

Enter amount from line 4

Enter 65% of the amount on line 8 coe

Enter 50% of the amount on line 12. . . F.

Enter unused capital loss carryover from preceding taxable. eld a ch computation)
Combine the amounts shown on lines 13, 14, 15 and 16

If line 17 shows q gain, enter here and on page 2, Part II of Form 540. or '540NR

If line 17 shows: a loss, enter here and on page 2, Part It of Form 540 or 540NR the smallest of:
(a) amount on lines 17;

of capital assets; or
(c) $1 000 ($500 in the case of a husband or wife filing a separate return)

Docld:3224553§. .Rage-26 —_ ra ener emer pe enn ae _ —— ai a oe :

,
ed

4
i

“NW 88326 Docld:32245535 Page $7

. Please attach Copy B of Forms W-2 here ]|7

- Department of the Treasury—=IntéKe Revenue Service
US Individual Income Tax Return \

For the year January t-December 41, 1975, of other Gtx. ible year beginning > fou ce we TOFS, CHB oo ee

Your social security number | For Privacy Act Notification, a

7 Name (If joint —_ give first a. pe als of both) Last name

2 SJ AM nE é& l C.. Tk \ AB 322 Ju 29? ? see page 2 of Instructions. ek
: Present home addsess rate and ae ifeluding apaitment number, of rural sgute wn | Spouse's e security no. , For IRS use only ue
5 sO fi ReHER Io BF LE. Ro Ge: phd EET)

3 State and ZIP code : Occu- |_Yours _

* (ees. A pation |" cpouse’s B 5 : v

Requested by Ain what ay. town, village, | Bo Do you live within the legal | C tn’ what county and State do you live? | O In Tranatlownenin do

Census Bureau etc., do y Al . - + limits of the city, town, etc.? | County : State you live? (See page 4.)
for Revenue Pot} _ , po, . a
Sharing Lo. Ss ApoE Ares [7] No [_] Don’t know Fey Hi CA goo . ae
Ly Sine te 6a Regular re ea ME Spouse Lowes chewed | Del
a 2 it Married filing joint return (even if only one had income) b First names of Pay dependent . chiidren who ,
3 3 {2} Married ni separate Ul rst ue filing five g lived with vert Ext S _ .
spouse's social security number in designated ‘space above | 2 Ae Enter +
a and enter full : a Ht 077 - number > os
fev) name here > : E c Number of other dependents (from line 27) .. mm |_
& 4°([] Unmarried Head, of Household (See page 5 of Instructions) | @ d Total (add lines Ga, b, and c) a
= , a ’ woe ee
a . ; tte Age 65 or over. . [|] Yourself [1] Spouse. number .
5 [J] Qualifying widow(er). with dependent child (Year Blind . . ... [7] Yourself [7] Spouse Checked pe
spouse died ® 19 ). See paye 5 of Instructions. 7 Tota! (add lines 6d and e) err
8 Presidential Election Do you wish to designate $1 of your taxes for this fund? too __ Yes |Z Z No Note: If you check the "Yes"
Campaign Fund . Al joint return, does your spouse wish to designate $1? . ai FNo- to or teduee your relund.

(Attach Forms Wed. If unavail-
able, see page 3 of Instructions.) *

‘

9 Wages, salaries tbs, “and other employee compensation

10a Dividends Ge oes at) g weet t? cece es , 10b Less exclusion $.. . tf ? Balance >

e (if gross dividends and other distributions are over $400, list in Part 1 of Schedule B)
es . 1f $400 or less, enter total without listing in Schedule B

8 | al Interest ingame, [ Hoover $400, enter total and listia Part Hoof Schedule B

£ 120 Jncome other tha wages, dividends, aad interest (from Hine AG), :

“1 43. Total (add lines 9, 10c, 11, and 12)-. 6 6

14 > Adjustments to income (such as "sick pay,”” moving expenses, etc. from line 42).
(if less than $8, 000, see paze 8 of In-
15 Subtractdine 14 from tine 13 (Adjusted Gross Income) Chasers on ‘‘Earned Income Credit."’)

@ If. you do not itemize deductions and line 15 is under $15,000, find tax in Tables and enter on line- 16a: : :
e If you itemize deductions or line 15 is $15,000 or more, go to line 43 to figure tax. Val a
@ CAUTION. if you-have unearned income and can be claimed as a dependent on your parent's return, check here B [|_| and see page 7 of insttuctions : -

Tax Tables
ScheduleD | +

Tax Rate Schedule X, Y, or Z
Schedule G | OR LI Form 4726

b Credit for personal exemptions (multiply line 6d by $30)

c¢ Balance (subtract line 16b from line 16a) .
17. «Credits (froni line 54) Loe
18 Balance (subtract line 17 from line 16c) . a
19 Other taxes (from line G3) , .
20 Total (add lines 18 and 19) . Thee Fe
21a Total Federal income tax. withheld a tae forms 2 "| 21a — 2?

16a Tax, check tf from:

|

Tax, Payments and Credits

"Please attach Check or Money Order here|

_20 | =O PP
Yee YL Ultithiyy Wy:

{include amount allowed as” yy Pay amount on line 23 in.
1975 estimated tax payments credit trom 1974 return) > —— y full_with this return. wit Z
YH social security number on

b
c Earned income credit

d Amount paid with Form 4868 .
e

Other payments (from line 67) .
22> Total (add lines 21a through e)

¢ “ wy check or money. order and
d|- : ‘ y make payable to Internal Ah,
e

— Yi yyy

2 23 If line 20 is larger than line 22, enter BALANCE DUE IRS . re 23 - .
ac _-(Check here > C] , if Form 2210, Form 221UF, or statement is attached. See p page 8 of Instructions.) . . -
2% 24 Mf line 22 is larger than line 20, enter amount OVERPAID. . . . 2. 1. 6 we 24 .
E@®! 25 Amount of line 24 to be REFUNDED TOYOU .. .. 6s 2 > | 25.

BB) 26 Avot of me 24 whe cise || Va OEE AEE PY

i] ited on 1976 estimated tax. >» 26 Ze retunded (line 2 25), make no entry on liste:2 %Z

hth hispad ddd lf fs
Under penalties of perjury, | declare that i have examined this return, including accompanying schedules and statements, and te the best of my knowledge and aie it
is true, correct, aad complete, Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Sign ; | 4
h : ‘ \ ‘ on . : : a 4
ere ee RN TTI .

. . ) . . Preparer’ s signature (other than taxpayer) - . Date
ml ye ‘ get a .
b—. a __| |. on 3O-3y_-£99.

"$ \gi i Ailin/jointly, BOTH must sign even if only one had income) Address (and ZIP Code) a
: 7 ae “oY ; oo, Soh Meares.

t, Form 1040 (1975) ; : Page 2
: tet (a) NAME (b)” Relationship {c) Months lived in your (ag) Did de- {e) Amount YOU (ft) Amount — fur-
2 * “ . ome. If born or died | pendent have | furnished for de- nished by OTHERS
ec ong year, write B or D. income of pendent’s sup- including .depend-
u - @ $750 or more? port. If 100% ent.
ts oy write ALL.
£c
ro} 2 a en OD $
ra
27 Total number of dependents listed in column (a). Enter here and on line 6... ee
i MZUEMM !ncome other than Wages, Dividends, and Interest :
7m 28 Business income or (loss) (attach Schedule C). . . . . . . rs 28 7,
4 29a Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) to. ee [298 4 ») .
29b 50% of capital gain distributions (not reported on Schedule D—see page 9 of Instructions) .-. 29b *
30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form ATS7). . 30 23) 3
: 3la Pensions, annuities, rents, royulties, partnerships, estates or trusts, etc. (attach Schedule E).  . _Sla_ —
31b Fully taxable pensions and annuities (not reported on Schedule E-—see page 9 of Instructions) . _31b_ ee
| 32) Farm income or (loss) (attach Schedule F) . 6. toe ee BRU
: ] pt apply if refund is f hich took th °
33. State income tox refunds (Sin sete voutaok tne) [aa
34 Alimony received : 34 |

: 35 Other (state nature and source—See pape ‘9 of Instructions) » |

nee ne sete tee cee tere cee eee

|

nit

36 “Total (ada lines 28 throug h a5). Enter here and on line 12, — ee 7 : ; ad 3

EGS Adjustments to income

| e -37 “Sick pay.” (attach Form 2440 or other required statement). - oe, woe ee | BFE _
; 38 Moving expense (attach Form 3903) . . . . ee _
| 39 Employee business expense (attach Form 2106 or statement) Soe ee 39 _

40a Payments to a Keogh (H.R. 10) retirement plan... wee ew ee | 40a : : .

: 40b Payments to an individual retirement arrangement from attached Form 5329, Part Mu 2... | 40b_ 37 s ~~
4 41 Forfeited interest penalty for premature withdrawal-—-see page 10 of Instructions rn 2 oe _

42. Total (add lines 37 through 41). Enter here and online 14... re 42 3 2 o

a | Part (it BES Computation (Do not use this part if you use the Tax Tables to find your tax.)

A -43 Adjusted gross income (from line 15). . : soe. AB
. “44 (a) If you itemize deductions, check here > 7 and enter total trom Schedule A, line a

= and attach Schedule A es soe

y : (b) If you do-not itemize deductions and line 15 is ‘$15, 000 or more, check here >» cr] and:. 44
7 : (€ box on line 2 or 5 is checked, enter 16%, of line 15 but not more than $2,600: if box os
o ‘on line 1 or 4 is checked, enter $2,300; if box on line 3 is checked, enter $1,300 :

a . 45 Subtract line 44 from line 43... ee
7 46 Multiply total number of exemptions claimed on line 7, ‘by $750 . Coe ee eee | 46

AO 47 Taxable income. Subtract line 46 from line 45 2 6 ee ee we LAT
, (Figure your tax on the amount on line 47 by using Tax Rate Schedule X, Y, or Z, or if applicable, the alternative .

57 Minimum tax. Check here m [7j, if Form 4625 is attached. . eee ee ee

58 Tax on premature distributions from attached

4 tax from Schedule D, income averaging fram Schedule G, or maximum tax from Form 4726.) Enter tax on line 16a.
a 2\ 48 Retirement income credit (attach Schedule R) . ee res a. :
: 2 49 Investment credit (attach Form 3468). 20 ee ee | AB
: ©! 50 Foreign tax credit (attach Form 1116) . . - 50
| 51 Contributions to candidates for public office credit—-see page 10 of Instructions . 51
' 52 Work Incentive (WIN) credit (attach Form 4874)... 27. et we we ee [82
53 Purchase of new principal residence credit (attach Form 5405). 2. . 2. ee 53
: - 54 Total (add lines 48 through 53). Enter here and on line 17... 54
i 3 55 Tax from recomputing prior-year investment credit (attach Form 4255) WeTRsE; 55 —oO =<
‘ pi 56 Tax from reconiputing prior-year Work lacentive (WIN) credit (attach Schedule) . 56
he
rT)
r=
Cad
fe)

aie Ss
59 ‘Self-employment tax (attach Schedule SE) . ey eG): 19 0.

4 60 Social security tax on tip income not reported to employer (attach Form.4137) .

60
“ig 61 Uncollected employee social security tax on tips (from Forms W-2) 61
“es 62 Excess contribution tax from attached Form 5329, Part IV... 0. 6 ee 62 ,

i 63 Total (add line ob pb Hirguyh h os 2). F Enter here and on tine 19.0. 0. ke, oe pee 7 ‘od

. B2GAUM Other Payments

! 64 Excess FICA, RRTA, or FICA/RRTA tax withheld (two or more employers—see page 10 of Instructions). :. . 2 1 64 .
A 65 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form 4136) | rn 65 : .
a 66 Credit from a Regulated Investment Company (attach Form 2439)). «6. ee ee ee 66 : ea

4 67 Total (add lines 64 through 66). Enter here and on line 2le re 67

ot te U.S. GOVERNMENT PRINTING OFFICE ; 1975-O-575-050 . , . , S 16-82510-1

NW 88326 Docld:32245535 Page 28


:
4
a
j
ft
t

{

t
a
i

'

Schedules A&xB—ltemized Deductions AND:
(Form 1040) Dividend and Interest Income
Department of the Treasury b> Attach to Form 1040. p> See Instructions for Schedules A and B (Form 1040).

Internal Revenue Service
AYCLIS k

meme shown -on Form 1040
Au € lL ZL

Schedule A—lItemized Deductions (Schedule B on back)

Your social security ey) 7.

Medical and Dental Expenses (not compensated by insurance | Contributions (See page 12 of Instructions for examples.)

or otherwise) (See page 11 of Instructions.)

1 One half (but not more than $150) of in- ;
surance premiums for medical care. (Be
sure to include in line 10 below) - Pe

2 Medicine and drugs . . . woe _—
3 Enter 1% of line 15, Form 1040 foe fe

2k a Cash contributions for which you have

receipts, cancelled checks or other
written evidence :
b Other cash contributions. List donees
_ and amounts. Bm |

4 Subtract line 3 from line 2. Enter differ-
ence (if less than zero, enter zero)... |_| _

5 Enter balance of insurance premiums for
medical care not entered on line 1 2. |

6 Enter other medical and dental expenses:
_ a Doctors, dentists, nurses, etc. 2... |-—_——] ——
>p Hospitals. . . - (i
ec Other (itemize—include hearing aids,
dentures, eyeglasses, ‘transportation,
etc.) >

22 Other than cash (see page 12 of instruc-
tions for required statement) . .
23 Carryover from prior years

24 Total contributions (add lines 2la through / f O

23). Enter here andonline38 . . . >»
Casualty or Theft Loss(es) (See page 13 of Instructions.) :
Note: /f you had more than one loss, omit lines 25 through 28
and see page 13 of Instructions for guidance,

25 Loss before insurance reimbursement .
26 Insurance reimbursement

|

27 Subtract line 26 from line 25. Enter dif-
ference (if less than zero, enter zero)

7 Total (add lines 4 through 6c) . .). J] ——
8 Enter 3% of line 15, Form 1040 . .  . |—___-__-|-_

9 Subtract line 8 from line 7 (if less than
- zero, enter zero) cee

10 Total (add fines 1 and 9). Enter here and /
on line 35 : Is2

28 Enter $100 or amount on line 27, which-
ever is smaller . .
29 Casualty or theft loss (subtract ti line 28

from line 27). Enter here and on line 39°

Miscellaneous Deductions (See page 13 of Instructions.)

30 Alimony paid

Taxes (See page il of Instructions.) 31 Union dues .
11 State and local income... - + |__| — 32 Expenses for child and dependent care
12 Real estate. . . .- . _ services (attach Form 2441)
13 State and local gasoline (see gas tax . tables) 33 Other (itemize) PM ooo
14 General sales (see sales tax tables) :
15 Personal property . . : .
16 Other (itemize) ® owe. | | =e oon e swe cee ceceueaneeeeeeseeetnn nee ceeees
a SCe
17 Total (add lines 11 through 16). Entor | 207, 34 Total (add lines 30 through 33). Enter
here and on line 36... here and online 40 ._. > :
E e Fy f I . . .
interest xpens (See page 12 oO asleuctions) Summary of Itemized Deductions A |
18 Home mortgage . : .

35 Total medical and dental—line 1

36 Total taxes—line 17 .

37 Total interest-—line 20 .

38 Total contributions—line 24

39 Casualty or theft loss(es)—line 29 .
40 Total miscellaneous—line 34 .

19 Other (itemize) P ...........2 eee

41 Total deductions (add lines 35 through
20 Total (add Jines 18 and 19). Enter here
and online 37... ee ad

oNW 88276 Dochd:32245535 Page 29

1975 Y

“SCHEDULE C Profit or (Loss) From Business or Profession

-Name(s) as shown

vl
af
t
a

tye OH

(Form 1040) (Sole Proprietorship) ; \ 7
Department of the Treasury > Partnerships, Joint Ventures, etc., Must File Form 1065. -
Internal Revenue Service » Attach to Form 1040. » See Instructions for Schedule C (Form 1040). :

on Form 104
we L LiL
A Principal business activity (see Schedule C ins! ctions) | ae
B Business name » [4/0.0 2 LEY
D Business address (number and street
City, State and ZIP code B........
E Indicate method of accounting: (1) im Cash (2) Mw Accrual @) go Other >»
F Were you required to file Form W-3 or Form 1096 for 1975? (see Schedule C Instructions) .
If “Yes,” where filed >
G Was an Employer's Quarterly Federal Tax Return, Form 941, filed for this business for any quarter in 1975?

™ oa By eT ayy roduct Moa. fats ~ Gove lay nn
oC dag y 206 OR ver identification number >. 95-% Re. (SUP

H Method of inventory valuation Bo... wo cavevueceveseeeseseaerencseveecseee LL iuvceceeeeeeesstesceteneceess Was there any substantial change in
the manner of determining quantities, costs, or valuations belween the opening and closing inventories? (IC “Yes,” atlact explanation)
1 Gross receipts or sales $...0000 ee Less: returns and allowances $..........--- weesteeeeeees Balance > ch | lccceestececeeceneeeeeenee [eee
E Less: Cost of goods sold and/or operations (Schedule C-1, line 8) oe a
8 Gross profit en
= . Other income (atlach schedule) . A

Tota! income (add fines 3 and 4)

Taxes on business and business property (explain in Schedule c-2)
Rent on business property
_ Repairs (explain in Schedule C—2) tee .
10 Salaries and wages not inchided on line 3, Schedule c 1 (exclude 3 any ‘paid to yourself) :
11 Insurance . . .
- 12 Legal and professional fees
13 Commissions . Lee
14 Amortization (attach statement) . .
15 (a) Pension and profit- sharing plans (see Schedule Cc instructions)
(b) Employee benefit programs (see Schedule C Instructions)

2
3
4
5
6 Depreciation (explain in Schedule C-3)
7
8
9

16 Interest on business indebtedness

17 Bad debts arising from sales or services
18 Depletion .

19 Other business expenses (specify):

Deductions

(k) Total other business expenses (add lines 19(a) thrown 19(j)) .
Total deductions (add lines 6 through 19(k)) :

21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on | Form 1040, line 28. ALSO

enter on Schedule SE, line 5(a).  . . 21 ; |
SCHEDULE C-1.—Cost of Goods Sold and/or Operations (See “Schedule a instructions for Line 2)-

1 Inventory at beginning of year (it different from last year’s closing inventory, attach explanation) .
Purchases $......0.0....-....ee Less: cost of items withdrawn for personal use $............ cee Balarce >
Cost of labor (do not include salary paid to yourself)

Materials and supplies

Other costs (attach schedule)

Total of lines 1 through 5

Less: Inventory at end of year -
8 Cost of goods sold and/or operations. Enter here and on ‘tine 2 above

NOU &@ WD

WG—-B82517-1

NW 88326 Docid:32245535 Page 30

«

: “Schedule C (Form 1040) 1975 ; Page 2
. a nS NEUSE nS SEINS NUS UES
sos, SCHEDULE C-2.——-Explanation of Lines 7 and 9 ,

ho , Line No. Explanation ‘Amount Line No. Explanation + Amount

SCHEDU LE C-

eprec ition (Seu Schedule C Instructions for Line G) If you need more space, you inay use Form 4562.

Note: If depreciation s computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, o1 or the Guideline Class. .

. . Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Life (ADR) System) or Form 5006 (Guideline _
Class Life System), Except as otherwise expressly provided in income tax regulations sections 1,167(a)-11(b)(5)(vi) and 1.167(a)-12, the pro-

visions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970. (See Publication 534.) |

Check box if you ‘made an election this taxable year to use [_} Class Lite (ADR) System and/or [_] Guideline Class Life System.

ev, Method of . yo
"computing {. Life g. Depreciation for
depreciation or rate this year

d. Depreciation
allowed or allowable
in prior years

a, Group and guideline class b. Date c. Cost or
ot description of property acquired - . other basis

_ 1 Total additional first-year depreciation (do not include in items below) ———-———___.-_.____________—_»
“2 Depreciation trom Form 4832 . + see Note \ + |--------eeeeeeeeee eee eee a
3 Depreciation from Form 5006 . \ ®Peve cece eee eeeteeteeeeeeeeees Yj
4 Other depreciation:

Buildings oo
Furniture and fixtures. .

Transportation equipment .
Machinery and other equipment
7 Other (specify)

5 Totals... 1. 1 ew we ee ee

6 Less amount of depreciation claimed in Schedule C-1, page 1

7 Balance—Enter here and on page 1, line 6 . - :
. SCHEDULE C~4.—-Expense Account Information (See Schedule Cc Instructions Tor Schedule Cad)

Enter information with regard to yourself and your five highest paid Name Expense account | _Salaries TE DOE
employeeg. In determining the five highest paid employees, expense y
account allowances must be added to their salaries and wages. How-
ever, the information need not be submitted for any employee for
whom the combined amount is Jess than $25,000, or for yourself if
your expense account allowance plus line 21, page 1, is Jess than

$25,000.
. Did you claim a deduction for expenses connected with:
(1) Entertainment facility (boat, resort, ranch, etc.)? . . [CT] Yes tyflo (3) Employees’ families at conventions or meetings? . . [) Ves
a (2) Living accommodations (except employees on business)? [7] Yes Thtve (4) Employee ot family vacations not reported on Form W-2? [7] -Yes

st U.S. GOVERNMENT PRINTING OFFICE + 19/5—(3 575-053 . Wi S2517-1

“NW 88326 Dochd:32245535 Page 31

ca on fa wlaSpaaeide
g .

“SCHEDULE D Capital Gains and LoSS@$& (Examples of property to be reported on this

“uy (Form 1040) Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but not
soot Department of the Teasuy | 'SSeS) on personal assets such as a home or jewelry.)
intemal Revenue Service m Attach to Form 1040. ® See Instructions for Schedule D (Form 1040).

Social security number

——

Narne(s) as shown on Form 1040

JAmuge
EZUAMEE Short-term Capital Gains and Losses—Assets Held Not More Than 6 Months

320.

. . b. Date c. Date e, Cost or ant basis,
. Kind of property and description acquired “sold d. Gross sales price .8s adjusted (see f. Gain or (toss)
pos téxample, 100 shares of ‘'2”' Co.): (Mo., day, yr.) (Mo., day, yt.) instruction and (d less o
! 1 a,
nn | ae | | ee |

' a Oe
1 hn Ran OS I
i a rs
{ i es a | | | a Fe

‘ a | em | eee nee | a | nn | ae
~ 8 2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries . 2... |
we 3 Enter not gain or (loss), combine lines lund 2.0.0.) . a ee ee

7 4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction 1)
: (b) Short-term: capital loss carryover attributable to years beginning after 1969 (see Instruction 1).

‘ a) Net short-term gain or (loss), combine lines 3, 4(a) and (b) . . . so
j ESL Long-term Capital Gains and Losses——Assets Held More Than 6 Months a .
" 6 . + _ ”
a —
4 a —
Fl S(O a UF
4 —_— _
4 .
‘t
| 7 Capital gain distributions. . . . toe ee as ee ae a
H 8 Enter gain, if applicable, from Form 4797, line 4(a)(1) (see instruction A) woe eee ee 8 Sf OS :
9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries .. . _39_ .
10 Enter your share of net Jong-term gain from small business corporations (Subchapter S). . . 10
11 _—Net gain or (loss), combine lines 6 through 10... . ee ee ew ee ee | SOS ;
4 12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction |) . 12(a)|_¢ 3 |
i (b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction y. |)" _
° 13 Net long-term gain or (loss), combine lines 11, 12(a) and (b)_. we 13
{ [eam Summary of Parts | and Ab
14 Combine the amounts shown on lines 5 and 13, and enter the net gain or (loss) here. 2. .

4 15 \f line 14 shows a gain—
(a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part VI for computation

\ . of alternative tax). Enter zero if there is a loss or no entry on line 13... ro -

(b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29a. . 1.

: 16 If line 14 shows a loss—
4 a & If losses ure shown on BOTH lines 12(a) and 13, omit lines 16(a) and 1) and yo to Part iV
. : (see Instruction J).
, » Othemise,
mo (a) Enter one of the following amounts:
oe . : (i) If amount on line 5 is zero or a net gain, enter 50% of amount on line 14;

. (ii) f amount on line 13 is zero or a net gain, enter amount on line 14; or
a : ’ (iii) If amounts on line 5 and line 13 are net losses, enter amount on line’ 5 added to
i 50% of amount on line 13... tone

: : (b) Enter here and enter as a (loss) on Form 1040, line 29a, the smallest oft

‘ : (i) The amount on line 16(a);

of . (ii) $1,000 ($500 if married and filing a separate return—if a loss is shown on line
. 4(a) or 12(a), see instruction N for a higher limit not to exceed q $1, 000); or,

(iii) Taxable income, as adjusted (see Instruction M) . . - os

16-—82511-1

“NW 88326. Docld:32245535 Page 32 oe ae

Schedule D (Form 1040) 1975

17
18

20

22
23
24
25
26
27
28
29

31

33
34

Part IV Capita! Loss Limitation—Where Losses Are Shown on Both Lines 12(a) AND 13

Enter loss froni line 5; if line 5 is Zero or a gain, enter a zero .
Enter loss from line 13... 2 we
Enter gain; if any, from line 5; if line 5 is zero or a loss, enter a zero .
Reduce !oss on line 18 to the extent of the gain, if any, online 19 -

Combine lines 3 and 11 and if gain, enter gain; if zero ora loss, enter a zero

2 | 5/0 |

Note: if the entry on linc 21 is zero, OMIT lines 22 though 28, and enter on line 29 the
loss shown on line 12(a).

Enter gain, if any, from line 11 . .

Enter smaller of amount on line 21 or line 22 .

Enter excess of gain on line 21 over amount on line 23
Enter loss from line 4(a); if line 4(a) is blank, enter a zero .
Reduce gain, if any, on line 24 to the extent of loss, if any, on line 25 (see instruction K) 26
Enter loss from tine 12(a) .

Siieerd *“ameen

Add the gain(s) on line(s) 23 and 26.0... ee ee 28 | Ss OS
Reduce the loss on line 27 to the extent of the gain, if any, on line 28 (see Instruction L) .

Enter smaller of amount on line 29 or line 20 (if line 29 is zero, enter a zero) .

Subtract amount on line 30 from the loss on line 20 .
Enter 50% of the amount on line 31.

Add lines 17, 30, and 32 so

Enter here and enter as a (loss) on Form 1040, line 29a, the ¢
(a) Amount on line 33;

smallest of:

(b) $1,000 ($500 if married and filing a separate return—see Instruction N for a higher limit not to exceed hae 000); or,

(c) Taxable Income, as adjusted (see Instruction M) .

14 (See Instruction N)

35

j 36
37
7 38
_ 39
40
: 41
J 42

43

B28 Computation of Alternative Tax (See Instruction W to See if the Alternative Tax Will Benefit You)

: 44
a 45
a 46
_ 47

Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a Zero .

Note: if the entry on line 35 is zero, OMIT lines 36 through 42, and enter on line 43 the loss shown on

line 4(a).

Eriter gain, if any, from line 3 .

Enter smaller of amount on line 35 or line 36 .

Enter excess of gain on line 35 over amount on line 37 .

Enter loss from line 12(a); if line 12(a) is blank, enter a zero . .

Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 9 (see ‘Instruction K).
Enter loss from line 4(a) .

Add the gain(s) on line(s) 37 and 40. .
Reduce the loss on line 41 to the extent of the gain, if any, on line 42 (see Instruction Lb.

29
30
31
32
33,

|

|

ul form»

Complete Part V if You are Married Filing a Separate ‘Return and Losses are Shown on Lines 4(a) and

35

Enter amount from Form 1040, line 47 .

Enter amount from tine 15(a) . ee
Subtract amount on line 45 from amount on line 44 (but not less than zero) .
Enter smaller of amount on line 13 or line 14 .

If line 47 does not exceed $50,000 ($25,000 if married filing separately), check here > q and omit

lines 48 through 54.

u 48

49

50
51
: 52
53
- 54
a 55
56
57

s vo
ONW 88226 Docld:32245535 Page 33

Enter your share of certain long-term gains from partnerships, fiduciaries, and small business cor-

porations referred to as “certain subsection (d) gains” (see Instruction W) .

Enter amount from line 48 or $50,000 ($25,000 if married filing separately), whichever is larger .

If line 49 is equal to or greater than line 47, check here > [] and omit lines 50 through 54.
Multiply amount on line 49 by 50% .

Add amounts on lines 46 and 50 . woe eee

Tax on line 44 or 45, whichever is greater (use Tax Rate - Schedule in instructions) ©

Tax on the amount on line 51 (use Tax Rate Schedule in instructions)

Subtract amount on line 53 from amount on line 52 . .

Tax on the amount on line 46 (use Tax Rate Schedule in instructions) . .
If the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 259, of line 49

Alternative Tax—add amounts on lines 54 (if applicable), 55, and 56. If smaller than the tax figured

on the amount on Form 1040, line 47, enter this alternative tax on Form 1040, line 16a

ir U.S, GOVERNMENT PRINTING OFFICE ; 1975—O-575-054

57

‘ on the amount on Form Use ine a eee eee 00 ,

16-=B2511-1

4
H
|
:

NW 88326 Docld:32245535 Page 34

rr re ea arin nae ieee”

Oe 1040) _| Computation of Social Security Self- Employment Tax . 1975

Department of the Treasury p> Each self-employed person must file a Schedule SE. p> Attach to Form 1040.
Internal Revenue Service > See Earned Income Credit Instructions on page 8 and instructions for Schedule SE (Form 1040).

@ If you had wages, including tips, of $14,100 or more that were subject to social security or railroad retirement taxes, do not fill'in
this schedule unless you are eligible for the Earned Income Credit. See Instructions. . 6

@ \f you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.

Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits,
NAME OF SELF-EMPLOYED OF SHOWN ON SOCIAL SECURITY CARD) Social security number of
self-employed person >» 2 rw!

Business ae an to self- AB ent tax (grocery store, restaurant, farm, etc.) »» ¢

@ If you have only farm income complete Parts t and tll. @ If you have only nonfarm income complete Parts II and Ml.
@ If you have both farm and nonfarm income complete Parts |, fl, and Ul.

Giza Computation of Net Earnings from FARM Self-Employment
You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line

2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and -
2 must be completed even if you elect to use the FARM OPTIONAL METHOD.

‘2

REGULAR METHOD (a) Schedule F, line 54 (cash method), or line 74 (accrual method) .
1 Net profit or (loss) from: (b) Farm partnerships . . . . . . wee
2 Net earnings from farm self-employment (add lines 1(a) and (b)) . 2. see :
31 gross profits METHOD | (a) Not more than $2,400, enter two-thirds of the gross = profits rn Ie :
from farming ' are: (b)} More than $2,400 and the net farm profit is less than $1,600, enter $1, 600 .

1Gross profits trom farming are the total gross profits from Schedule F, line 28 (cash method), or tine 72 (acerual
method), plus the distributive share of gross profits from farm partnerships (Schedule K-I (Form 1065), tine 14) as Y
explained in instructions for Schedule SE. yy Le ee

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method .

BENG Computation of Net Earnings from NONFARM Self-Employment

(a) Schedule C, line 21. (Enter combined amount if more than one business.)

Wii

; (b) Partnerships, joint ventures, etc. (other than farming) . . . 2. . 1.20. 2.04
REGULAR METHOD | (c) Service as a minister, member of a religious order, or a Christian Science prac-
5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished.) If you

(loss) from: filed Form 4361, check here B® [] and enter zero on this tine

(d) Service with a foreign g government or international organization
( 1
(e) Other Structions for line 35.) Specify >

6 Total (add tines 5(a) through (e)) .
7 Enter adjustments if any (attach statement) . . . . to . . oo. -
8 Adjusted net earnings or (loss) from nonfarm self- employment (line 6 6, as adjusted. by | line ”». :
_ If line 8 is $1,600 or more OR if you do not-elect to use the Nonfarm Optional Method, omit-lines 9 through
11 and enter amount from line 8 on line 12(b), Part Il.
Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than. $1,600 and less
than two-thirds of your gross nonfarm profits,’ and you had actual net earnings from: self-employment of $400 or more
for at least 2 of the 3 following years: 1972, 1973, and 1974. The nonfarm optional method can only be used for 5
taxable years.
NONFARM OPTIONAL METHOD :
9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .

(b) Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero.) . im
(c) Balance (subtract line 9(b) from line 9(a)) . 2. . 1 ww oe ee
10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is smaller ee ee ek ea
11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller. . . .

2Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3; plus the distributive
share of gross profits from nonfarm partnerships (Schedule K-1 (Form 1065), line 14) as explained in instructions
for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7.

eke Computation of Social Security Self-Employment Tax
12 Net earnings or (loss): (a) From farming (from line 4). 2. 7. 2 we ee toe eee ;
(b) From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) . woe ee

13 Total net earnings or (joss) from self-employment reported on line 12. (If Line 13 is less than $400, you are not
subject to self-employment tax. Do not fill in rest of schedule.) .

14 The largest amount of combined wages and seif- employment earnings subject to social | security ¢ or railroad

retirement taxes for 1975 is . . . . $14,100. 100
15 (a) Total “FICA’ wages and "RRTA” compensation. . . . Ff =
(b) Unreported tips subject to FICA tax from Form 4137, line 9 orto RRTA. . -
(c) Total of lines 15(a) and (b) 2. we ew me - oe oe
16 Balance (subtract line 15(c) from line 14) 2.) ww “ee neon es
17 Self-employment income—line 13 or 16, whichever is smaller... . eg
18 Self-employment tax. (If line 17 is $14,100.00, enter $1,113.90; if less, muriply ¢ the amount on line 7 Yos
by .079.) Enter here and on Form 1040, line 59. . .

yr U.S, GOVERNMENT PRINTING OFFICE : 1975—O-575-058 . . , N-B2518-3

ve

od

“4
ad

\

“SCHEDULE SE enn: , at tT:
(Form 1040) Computation of Social Security Self-Employment Tax
Department of tho Treasury p> Each self-employed person must file a Schedule SE. p> Attach to Form 1040.

Internal Revenue Service B Sce Earned Income Credit Instructions on page 8 and Instructions for Schedule SE (Form 1040).

@ If you had more than one business, combine profits and lasses from all your businesses and farms on this Schedule SE.

1a

@ if you had wages, including tips, of $14,100 or more that were subject to social security or railroad retirement taxes, do not fill in
this schedule unless you are eligible for the Earned Income Credit. See Instructions.

Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.

NAME OF ,SELF-EMPLOYED RAB SHOWN ON SOCIAL SECLIRITY CARD) Social security number >| 9

LLvs¢

self-employed person »
Business activities subject to self- A.B tax (grocery store, restaurant, farm, etc.) >» Sf

@ If you have only farm income complete Parts | and lil. @ If you have only nonfarm income complete Parts II and Ht

@ If you have both farm and nonfarm income complete Parts |, H, and Ilt.

EZ ~ Computation of Net Earnings from FARM Self-Employment .

. You may elect to compute your net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, line

2, if your gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1, 600. However, lines 1 and

2 must be completed even if you elect to use the FARM OPTIONAL METHOD.

REGULAR METHOD (a) Schedule F, line 54 (cash method), or line 74 (accrual method) .
1 Net profit or (loss) from: (b) Farm partnerships ee
2 Net earnings from farm self-employment (add lines 1(a) and (b)) . yee
FOR once otis METHOD | (a) Not more than $2,400, enter two-thirds of the gross s profits see
"from farming’ are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 .
1Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 (accrual —

method), plus the distributive share of gross profits from. farm partnerships (Schedule K-1 (Form 1065), line 14) as
explained in instructions for Schedule SE.

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method
| Computation “of Net “Earninigs trom” NOI “NONFARM S “Self-Employment ~~

(a) Schedule C, line 21. (Enter combined amount if more than one business.) Lone

(b) Partnerships, joint ventures, etc. (other than farming) . . . . ee ee

REGULAR METHOD|.{c) Service as a minister, member of a religious order, or a Christian Science prac-

5 Net profit or titioner. (Include rental value of parsonage or rental allowance furnished.) If you
(loss) from: filed Form 4361, check here » [[] and enter zero on this line
: (d) Service with a foreign Bovernment or international organization

(e) Other Crastions tor line. 35 35) Specify De eee cece eee cence ee npeecnvsenevaceaeeeraeee

6 Total (add lines 5(a) through (e)) . 2. 1. ww ee
7 Enter adjustments if any (attach statement)

8 Adjusted net earnings or (loss) from nonfarm self- employment ‘tine 6, as 5 adjusted: by line 2). .
If tine 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 9 through
11 and enter amount from line 8 on line 12(b), Part IIL.
Note: You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than $1,600 and less
than two-thirds of your gross nonfarin profits,” and you had actual net earnings from self-employment of $400 or more
tor at least 2 of the 3 following years: 1972, 1973, and 1974. The nontarm. optional method can only be used for 5
taxable years.
NONFARM. OPTIONAL METHOD .
’ 9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
(b) Enter amount from line 3. (If you did not elect to use the farm optional method, enter zero.) .
(c) Balance (subtract line 9(b) from line 9(a)) . 7 2. ww we eee ke
10 Enter two-thirds of gross nonfarm profits? or $1,600, whichever is smatler .. oe ee ee
11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller .
2Gross profits from noantarm business are the total of the gross profits from Schedule C, line 3, plus the distributive

share of gross profits fram nonfarm partnerships (Schedule K-1 (Form 1065), tine 14) as explained in instructions
for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as adjusted by line 7.

BZ Computation of Social Security Self-Employment Tax

12 Net earnings or (loss): (a) From farming (from line 4). 2 2 1. . Cone ete
(b) From nonfarm (from line 8, or tine 11 if you elect to use the Nonfarm ‘Optional Method)

13 Total net earnings or (loss) from self-employment reported on line 12. (Hf Line 13 is less than $400, you are not
subject to self-employment tax. Do not fiil in rest of schedule.) .

14 The largest amount of combined wages and self- employment earnings Subject to social | security ¢ or railroad
retirement taxes for 1975 is

15 (a) Total “FICA’ wages and “RRTA’’ compensation. . . . —— EZ
. (b) Unreported tips subject to FICA tax from Form 4137, tine 9 orto RRTA.. .

(c) Total of lines 15(a) and (by) ©. 7, ee ee
16 Balance (subtract line 15(c) from line 14) . 2. 2 we one Ce ee ee nk ke

17 Self-employment income—line 13 or 16, whichever is smaller . . . . soe

18 Self-employment tax. (If tine 17 is $14,100.00, enter $1,113.90; if ess, mutual & the amount on line 17
by .079.) Enter here and on Form 1040, line 59 . : eee
yc U.S, GOVERNMENT PRINTING OFFICE : 1973—-O-575-058

NW 88326 Docld:32245535 Page 35

___$14,100_

j 5G
Vee Leas %

es

16-8 2515-3

]
4

. :

NW 88326 Docid:32245535 Page 36

. 47197 Supplemental Schedule of Gains and Losses

u

Department of the Treasury ‘ Sections 1231, 1245, 1250, 1251, and’ 1252

Internal Revenue Service

Sales, Exchanges and Involuntary Conversions under 1975 a

g. be filed with Form 1040, 1041, 1065, 1120, etc.—See Separate Instructions

Identifying qumber

KUL’ BrL-/L-2FIP

ft Property Used in Trade or Basiness, and Involuntary Conversions .

J
Part . (Section 1231)

SECTION A.—Involuntary Conversions Due to Casualty and Theft (See Instruction E)

f. Cost or other basis,

a. Kind of property (if necessary, . . - e. Depreciation al. | cost of subsequent im- .
attach additional descriptive b. Date acquired] c. Date sold d. Gross sales lowed (or allowable) | provements (if not pur- g. Gain or (loss)
details not shown below) (mo., day, yt.) | (mo., day, yr.) price since acquisition | chased, attach explana. (d plus e less f)

tion) and axpense of sale

2 Combine the amounts on line 1. Enter here, and on the appropriate line as follows . 9... ee ee es

(a) For all except partnership returns:
(1) If line 2 is zero or a gain, enter such amount in column g, line 3. ; : : ;
(2) If line 2 is a loss, enter the loss on line 5, . : ; a
(b) For partnership returns: Enter the amount shown on line 2 above, on Schedule K (Form 1065), line 6.

tion A) (See Instruction E) :

4 Combine the amounts on line 3. Enter here, and on the appropriate line as follows .

(a) For all except partnership returns: . : .

(1) If line 4 is a gain, enter such gain as a long-term capital gain on Schedule D (Form 1040, 1120, etc.) that is being filed. See
instruction E.s -
(2) If line 4 is zero or a loss, enter such amount on line 6.

(b) For partnership returns: Enter the amount shown on line 4 above, on Schedule K (Form 1065), line 7.

~ Part Il. - Ordinary Gains and Losses

f. Cost or other basis,

a. Kind of property (if necessary, + e. Depreciation al- } cost of subsequent im- .
attach additional descriptive b. Date scauired| ¢. Date sold | 4. Gross sales rowed” tor allowable) | provements Cit ant pur | & Gain oy Cow)

details not shown below) (mo., day, yr.) | (mo., day, yr.) price since acquisition | chased, attach explana-
. : tion) and expense of sale

5 Amount, if any, from line 2(a)X(2) . - ew ee

6 Amount, if any, from line 4(a)(2) 2 6 ee
7 Gain, if any, from page 2, line 21

8 .

9 Combine amounts on lines 5 through 8. Enter here, and on the appropriate line as follows Coe
(a) For all except individual returns: Enter the gain or (toss) shown on line 9, on the line provided for on the

return (Form 1120, etc.) being filed. See instruction F for specific line reference.

(b) For individual returns: ; :

(1) If the gain or (loss) on line 9, includes losses which are to be treated as an itemized deduction on
Schedule A (Form 1040) (see instruction F), enter the total of such loss(es) here and include on
Schedule A (Form 1040), line 29—identify as ‘‘loss from Form 4797, line 9(b)(1)"" . ye,
(2) Redetermine the gain or (loss) on tine 9, excluding the loss (if any) entered on line 9(b)(1). Enter here
and on Form 1040, line 30... ee ee

16—82504-1 mo, 7 _ uo : Form 4797 (1975) =.


Forms 4797 (1975) : . . Page 2

Gain From Disposition of Property Under Sections 1245, 1250, 1251,
1252—Assets Held More than Six Months (See Separate Instructions) os
Disregard lines 18 and 19 if there are no dispositions of farm property or farmland, or if this form is filed by a partnership. ¢

10 Description of sections 1245, 1250, 1251, and 1252 property: . pute acquired, ima 4s

ai l2¥|. Lfad. far |

Relate lines 10(A) through 10(E) to these
columns > >» >» b>

Property Property Prope rty Property
« ) ” (D) :

11 Gross sales price . .
12 Cost or other basis and expense of sale .
13 Depreciation allowed (or allowable)

14 Adjusted basis, tine 12 less tine 13.

15_Total gain, line 11 lnss ine 14
i6 if section 1245 property:
(a) Depreciation allowed (or allowable) after ap
plicable date (see instructions) .
___(b) Enter smalier of line 15 or 16(a) .
17” If section 1250 property:
(a) Enter additional depreciation atter 12/31/83
‘and before 1/1/70:

(b) Enter additional depreciation after 12/31/69
(c
id

~~.

‘Enter smaller of line 15 or 17(3)

~~

Line 1/7(c) times applicable percentage (see
instruction G.4) ..

(e) Enter any excess of line 15 over line 1706) .
{f) Enter smaller of line 17(a) or 17{e) .

(g) Line 17(f) times applicable percentage. (see
instruction G.4)
4h) Add fines 174d) and 17)
18 Wf section 1251 property:
(a) ‘lf farmland, enter soil, water, and land clear-
ing expenses for current year and the four
Preceding years . .

(b) {f farm property other than land, subtract ‘ine : oo : ,
16(b) from line 15; OR, if farmland, enter
‘smaller of line 15 or 18(a) (see instruction
G5). ee

—

(c) Excess deductions account {see instruction
=D)

(d) Pier smaller of line 18(b) or “18(c)

19 If section 1252 property:
(a) Enter soil, water, and land clearing expenses .
made after 12/31/89 rs Le nesececececasfenecececeeceeceeecncee peceteeceenneereeecece] ennneeenecececpeeenere| pee geenegenenereeenes

(b) Enter amount from tine we F(a), if none enter a
zero .

(c) Enter any excess of line 19(a) over line 19(b)

(d) line 19(c) times applicable percentage (see :
instruction G.5) Fn nn Se oceeeseseeeececeeee | ccceeee en ee
(e) Line 15 fess line 19(b) .
(f) Enter smaller of tine 19(d) or 19{e) .
Summary of Part tll Gains (Complete Property columns 5 (A) through (E) through line 19(f) before going to line 20)

20 Total gains for all properties (add columns (A) through (E), line h-) - ye ee ee a ZY E-

“21 = Add columns (A) through (E), lines 16(b), 17(h), 18(d), and 19(f). Enter here and on line 7. . - soe 22/3-
”
fOS .

_ WULS, GOVERNMENT PRINTING OFFICE ; 199S—O-575-158 . _ . + . 16—-82.504-1

22 Subtract line 21 from line 20, Enter here and in appropriate Section in Part | (see instructions E and G.2) .

“NW 88226 Dochd:32245535 Page 37 i

rom 4798

Department of the Treasury
Internal Revenue Service

Name(g) as shown on Form 1040

A. Who Should File.—You wil! need to complete either

. Part i or Part Il of this form if you have a capital. loss to

carry over to 1975.

You will have a capital loss to carry to 1975 if the
amount on your 1974 Schedule D (Form 1040), line
16(a), or line 33, is LARGER THAN the loss deducted
on your 1974 Form 1040, line 29.

4

Capital Loss Carryover
> (From 1974 to 1975)
m» Attach to Form 1040.

Social Security Number

B. How to Compute Carryover.—lIf you have a capital
_ loss carryover, complete either Part | or Part li of this
form, but do not complete both.

1. Complete only Part-I if lines 4(a) and 12(a) on .
your 1974 Schedule D (Form 1040) DO NOT SHOW A
LOSS.

- 2. Complete only Part Il if either (or both) line 4(a) or
line 12(a) on your 1974 Schedule D (Form 1040) shows
a loss. ; —

MEZUAME Post-1969 Capital Loss Carryovers,

Section A,-—-Short-term Capital Loss Carryover

lines 2 through 6—then go to line 7

2 Enter gain shown on your 1974 Schedule D (Form 1040), line 13. i that line is blank or "shows

a loss, enter a zero
3 Reduce any loss on line 1 to the extent of any gain online 2 .
4 Enter amount shown on your 1974 Form 1040, line 29
5 Enter smaller of line 3 or 4 .

6 Excess of amount on line 3 over amount on fine 5

Enter loss shown on your 1974 Schedule D (Form 1040), line 5; if none, enter zero and ignore

Note: The amount on line 6 is your short-term capital loss carryover from 1974 to 1975 that is attributable to years beginning
after 1969. Enter this amount on your 1975 Schedule D (Form 1040), line 4(b). .

Section B.—Long-term Capital Loss Carryover

1040, line 29) .

8 Enter toss from your 1974 Schedule D (Form 1040), line 13: if none, enter zero and ignore lines

9 through 12

9 Enter gain shown on your 1974 Schedule D > (Ferm 1040), line 5. if that line is "blank or ‘shows

a loss, enter a zero
10 Reduce any !oss on line 8 to the extent of any gain on line 9
11 Multiply amount on line 7 by 2 .

12 Excess of amount on line 10 over amount on ‘line ll.

. 7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1974. Form

Note: The amount on line 12 is your long-term capital loss carryover + from 1974 ‘to ‘1975 that is attributable to years beginning
after 1969. Enter this amount on your 1975 Schedule D (Form 1040), fine 12(b). :

a

NW 88326 Docld:32245535 Page 38

Form 4798 (1975)


PO a beta, bb ret r E Ts

Form 4798 (1975)

a Pre-1970 and Post-1969 Capital Loss Carryovers

Section A.—Short-term Capital Losses Identified

1 Enter loss shown on your 1974 Schedule D (Form 1040), line 5; if none, enter zero and ignore
lines 2 through 20—then go to line 21
2 Enter gain shown on your 1974 Schedule D (Form 1040), | line 13, it that | line is ‘blank or "shows
a loss enter a zero tot thos
3 Reduce loss on line 1 to the extent of any gain on ‘ine 2.
i Note: /f line 4(a) on your 1974 Schedule D (Form 1040) is blank, IGNORE lines 4 through 11, enter
. a zero on line 12—then go to line 13.
4 Combine lines 3 and 11 on your 1974 Schedule D (Form 1040). -

Enter the gain; or if zero or a loss, enter a zero .

yo . Note: If line 4 is zero IGNORE lines 5 through 11, enter ¢ on line 12
the loss from your 1974 Schedule D (Form 1040), line 4(a)—
then go to line 13.

5 Enter any gain from your 1974 Schedule D (Form 1040), line 3.

6 Enter smalier of line 4 or 5 .

7 Enter excess of gain on line 4 over line 6. no.

; 8 Enter loss from your 1974 Schedule D (Form 1040), line 12(a):
to otherwise, enter a zero.. :

, 9 Reduce any gain on line 7 to the extent of any y loss ¢ on line 3.

a 10 Enter loss from your 1974 Schedule D (Form 1040), line 4(a); other-
: wise enter a zero . rT
11 Add the gains on lines 6 and 9 toe : .
12 Reduce the loss on line 19 to the extent of any gain on ‘tine ul.

: 7 13 Pre-1970 short-term capita! loss (Enter smaller of line 3 or 12) . .
14 Short-term capital loss attributable to years beginning after.1969 (excess 5 of line 3 over line 13)

15 Enter any loss from line 13, above .

16 Enter loss deducted on your 1974 Form 1040, line 29.
17 Loss carryover to 1975 (excess of line 15 over line 16—if line 15 does not exceed line 16, enter
zero). Enter here and on your 1975 Schedule D (Form 1040), line 4(a) .

1
at
{
{
*

18 Enter any loss from line 14, above .
‘19 Enter excess of line 16 over tine 15—if line 16 does not exceed line
15, enter zero : :
20 Loss carryover to 1975 (excess of line 18 over fine 19—if line 18 does not exceed line 19, enter
zero), Enter here and on your 1975 Schedule D (Form 1040), line 4(b) . .
21 If you were required to complete Part IV of your 1974 Schedule D
(Form 1040), enter any loss fram your 1974 Schedule D (Form
1040), line 30; otherwise, enter zero. . » ee {22
22 Enter excess of line 19 over line 18—if line 19 does not exceed line
18, enter zero. (Note: If you ignored lines 2 through 20 above, ¢ enter -
: 22 | —0-——
amount from your 1974 Form 1040, line 29.) tee eee
_ 23 Loss carryover to 1975 (excess of line 21 over line 22—if line 21 does not exceed line 22, enter
, : zero). Enter here and on 1975 Schedule D (Form 1040), line 12(a). . ee Be)
“ : 24 If you were required to complete Part IV of your 1974 Schedule D
(Form 1040), enter any loss from “your 1974 Schedule D (Form
1040), line 31. However, if Part IV was not required, enter any loss
from your 1974 Schedule D (Form 1040), line 13

25 Enter excess of line 22 over line 21 «........0. ee x2 Cif line 22 :
— O-—
does not exceed line 21, enterzero.). . . . . . 25 ;
26 Loss carryover to 1975 (excess of line 24 over line 25—it line 24 does not exceed line 25, enter Hl

zero). Enter here and on your 1975 Schedule D (Form 1040), line 12(b). . . . «| 26

W 88326 Docld:32245535 Page 39

gee a or
Vad ag tama ee OST ek leet

iA ad _ CALENDAR YEAR 19° PS
322—/2-7 SOC. SEC.-NO.
ne ; DEDUCTION SCHEDULE
;- MEDICAL STATE | FEDERAL [CONTRIBUTIONS -
* ° 2 MEDICINE/DRUGS : 1a CASH CONTRIBUTIONS
. - 3 LESS 1% A.G.I. (Line 18 - 1040) 21b PARTNERSHIP SHARE
1 _@NET MED/DRUGS GIRL/BOY SCOUTS

5H & AINS. (% + EXCESS) HEART FUND/CANCER FUND

STATE FEDERAL

:

a

|

A

al

| _Gapr. RED CROSS/UNITED FUND f
: DR. XMAS & EASTER SEALS ‘

MISC. ORGANIZED CHARITI§

CHURCHES

|

:

|_|

=

|_|

|_|

|_|

|__|

|

|_|

[| [22 0THER THAN CASH
[at eanaroven tron moa vast
=

| |

|

|

=

|_|

oo
Dina

X
3

LS.
CASUALTY OR THEFT (LUSS(E

25 LOSS BEFORE ADJUSTMENT

26 INSURANCE REIMBURSEMENT
27
26 ($100 LIMITATION PER CAS.)

MISCELLANEOUS DEDUCTIONS

6b HOSPITAL
PROSTHETIC APPLIANCES
HEARING AID

n

)

6c AMBULANCE
4, LABORATORIES
’ TRAVEL FOR MED.

eS
-

30 ALIMONY. - “
31 UNION/PROFESSIONAL DUES

32 CHILD & DEP. CARE (Form 2441)
33 INCOME TAX PREPARATION:
UNIFORMS/PROTEC. CLOTHING

11377 |_| sMALt TOOLS AND suPPLIES
| =} SO] | LauNnprRy AND CLEANING
| 1S 2) | | auto use/oamace

INVEST. COUNSEL & PUBS.(Sched
|__EMPLOYMENT AGENCY FEES
SAFE DEPOSIT BOX

POLITICAL CONTRIBUTIONS

MEDICARE INS.
GLASSES _
7] MEDICAL EXPENSES -
LESS REIMBURSED BY INS.
B LESS 3% ADJ. GROSS INC.
9
1+:% (TO $150)-OF H&AINS. >
+ (OTOTAL MEDICAL DED.
1 _TAXES
~  ALSTATE & LOCAL INCOME
AREAL ESTATE
1 T3STATE & LOCAL GASOLINE
1 14GENERAL SALES TAX
15a PERSONAL PROPERTY

I

2-T |

LOTT ' :
EUUTENOOUETREGEY UTE THVT ESS

| 1SbPERSONAL PROPERTY AUTO | -} 2
pf} 34 TOTAL MISC. DED.
es es Os
a —
+ ——| suman oF remo DEO
TTTOTAL TAXES IN 22 Xo A Se
INTEREST (TO WHOM PAID : 36 TOTAL TAXES (From LINE 17)
37 TOTAL INTEREST (Line 20)

38 TOTAL CONTR. (Line 24)

39 CAS. & THEFT LOSS(ES) ({Line29)

40 TOTAL MISCELLANEOUS : .
DEDUCTIONS (FROM LINE 34}

Al TOTAL ITEMIZED DEDUCTIONS
ENTER ON FORM 1040 LINE 45
R .

EMARKS

WDINSTALLMENT LOANS MJ LSC

| TRANS ALOR ED
- SBR _
i 7 ¥edDea

20 TOTAL INTEREST ie? <ou

Professional Stationers, lnc_
7440 Laurel Canyors Boulevard Form 101

“NW 8326 Docid:32245535 Page 40. oo, © SCHEDULE 7

AMOR TGAGE =
| TSE

SANT

s nn
m

. i]
m

us >
-

SERGRnn0
:
Coo


»
s

- NAME 1.0. NO. S 7 CALENDAR YEAR 19 2s
- >. - GP SOC. SEC. NO. ; ee
ADDRESS 3B22- - 2 FISCAL YEAR ENDING

?

EDULE OF PROFIT OR LOSS FROM BUSINESS OR PRO S UON
PRINCIPAL BUSINESS ACTIVITY
BUSINESS NAME . : EMPLOYERS NO.

BUSINESS ADDRESS

TOTAL RECEIPTS es es 7 et
|__|

: . S
INVENTORY AT BEGINNING OF YEAR (i f) ()

MERCHANDISE PURCHASED : . : Gj

RL
a , | 7 “Bye —
t LESS INVENTORY AT END OF YEAR ot |

GROSS PROFIT

GROSS INCOME
{ : - OTHER BUSINESS DEDUCTIONS

t

ADVERTISING oy a" iz

7 AUTO ANO TRUCK EXPENSE | rea

BAD DEBTS ‘
COMMISSIONS

me
DELIVERY .

DEPRECIATION ( SCHEDULE BELOW }

DUES AND SUSSCRIPTIONS

} > ENTERTAINMENT AND PROMOTIONAL . . :

{o. :

: _ INSURANCE : , : . Ke
Sa cE

Pt tO?
P|

an INTEREST
JANITOR ANO HAULENG

LEGAL AND ACCOUNTING

OFFICE SUPPLIES AND EXPENSE
i

RENT ‘ :
i REPAIRS AND MAINTENANCE ,
{ SALARIES AND WAGES .
' SUPPLIES .

oo. TAXES AND LICENSES

TAXES PAYROLL

een ENE
TELEPHONE AND UTILITIES.

tae ee. [NE N : a
| TIE RAC LALO QT

NET PROFIT OR (LOSS }) FEDERAL RETURN J

NET PROFIT OR (LOSS ) STATE RETURN - SEE DEPREC, SCHEDULE FOR DIFF, Gabsra ACs 9x7 ma
. SCHEDULE OF DEPRECIATION
" DATE COST OR
4 ; ; OTHER BASIS

' PROFESSIONAL STATIONERS INC FORM JO4A . mo . . ; ! .
LOS ANGELES, CALIF. oe re SCHEDULE

“NW 88326 Docid:32245535 Page 41


or YL Co
“NAME Samuel tay SOC. SEC. NO.

" DESCRIPTION OF PROPERTY.

ps KuBy

GAINS ON INSTALLMENT SALES

war

DATE ACQUIRED
TYPE OF ASSET: __

1. SELLING PRICE: CASH

‘Calendar Yr:
_F/Y/E 19
pate soto FP f 2S 7S
CAPITAL | SEC. 1245 "| SEC. 1250

2 NOTES ,

3 MORTGAGE TRANSFERRED
4 . OTHER
5. GROSS SALES PRICE (1+2+3+4)

6. COST OR BASIS

7. LESS ACCUMULATED DEPRECIATION

8 PRIOR TO 1-162 __

9. PRIOR TO 1—1-64
AFTER 12-31-61
ST. LINE AFTER 12-31-63

EXCESS OVER S/L.1—64/12-—69
; EXCESS OVER S/L AFTER 12—31-69
._ ADJUSTED BASIS (6-7 THRU 13)

“NW 88326 Docld:32245535 Page 42

NOFLEG CALIE enna ag

. EXPENSES OF SALE

. TOTAL ADJUSTED BASIS (14 + 15)
. TOTAL GROSS PROFIT (5 — 16)
18. TOTAL GROSS PROFIT — ORDINARY

. TOTAL GROSS PROFIT — OTHER
. CONTRACT PRICE (1 +2 +4)
1. GROSS PROFIT % —

. PAYMENTS RECEIVED YEAR OF SALE

CASH (1}

PRINCIPAL COLLECTIONS -
EXCESS MORTGAGE OVER BASIS
26... ° OTHER (4)

27. TOTAL PAYMENTS (23 THRU 26)

28. RECOGNIZED GAIN

29. RECOGNIZED GAIN — ORDINARY
30. RECOGNIZED GAIN — OTHER

ORDINARY INCOME

SECTION 1245

REPORTED

- TAX- TOTAL LESS INT.
ABLE PAYMENTS = [20,7732

CAPITAL GAIN

REPORTED

a
|

|

||

||

m

- BALANC

- eruEnI Ee


29 Married filing joint return (even if only one had income)

. INDIVIDUAL
CALIFORNIA

“INCOME TAX

PLACE PREADDRESSED LABEL HERE, if avaiable (Correct name and address, if necessary) ‘| Check “SaeCalendar Year
Enter social security number(s) only if incorrect or _not shown on label. - One: (7) Fiscal Year Ending._____-_1976
NAME_J(If joint return, MEL first p: initials of both} Aas NAME . CATION SEE BAGE SAE INSTRUCT ONS
AM Lf Your Social Security Number
. : ct i”

PRESENT TE Ee he (Number Ps tre

~~ Spouse's Social Securily Number
2¥9 : :
: [LE SF 24
occu. | Yours :
PATION | Soouse's

FILING STATUS oneck mar One:
1 Single

EXEMPTION CREDITS. | If fine 1 or 3 checked, enter $25
‘G Personal If line 2, 4 of 5 checked, enter $50

7 Dependents — Do not list yourself, your spouse or the person who qualifies you
as head of household. Enter name and relationship. .

__ELItA
. __CHOMMIA-S .
4 © Head of Household—Enter name of qualifying

individual 8 Blind (refer to instructions) Number of blind exemptions x $8
5 [) Widow(er) with dependent child (Year spouse died 197.) 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20

3 (1) Separate return of married person—Enter spouse’s
social security number and full name here

{ Attach copy 2 of Form(s) W-2 to face of this ?
10 Wages, salaries, tips and other employee compensation, return. it unavailable, see instructions, Page 6 {

11 Dividends—before federal exclusion. Enter total {if over $400, complete and attach Schedule (540) )
12 Interest. Enter total (if over $400, complete and attach Schedule B(540))-

13 Income other than wages, dividends and interest (from fine 48)

14 Total (add lines 10, 11; 12 and 13)

15 Adjustments to income (from line 55) ;

16 Adjusted gross income (subtract line 15 from tine 14)

© If line 1 or 3 is checked and line 16 is $4,000 or less, enter zero tax on line 23, Do not complete {
© If tine 2, 4, or 5 is checked and tine 16 is $8,000 or less, enter zero tax on line 23, } lines .17 thru. 22

© If you do NOT itemize deductions AND tine 16 is under $15,000, find tax in Tax Table and enter on line 19.
© If you itemize deductions OR line 16 is $15,000 or More, complete lines 17 and 18.

17 Deductions: Itemized (from line 62) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 of 5 checked)
18 Taxable income (subtract line 17 {rom tine 16) Compute tax fyem Tax Rate Schedule—Enter tax on line 19

“4 ATTACH COPY 2 OF FORM W-2 HERE

19 Tax from (check one) Tax Table [ Tax Rate Schedtteg7 Income Averaging Schedule (G or 6-1) 0
20 Total exemption credits (from line 9, above) . ,

21. Tax liability (subtract tine 20 from tine 19—if line 20 is greater” than line 19, enter aero)

22 Other credits (from tine 65)

23° Net tax liability (subtract line 22 from tine ait line 22 is s greater than “tine “21, enter 2et0)

24 Tax on preference income (see instructions—attach Schedule P(540) )

25 Total tax liability (add lines 23 and 24)

26 Total California income tax withheld (attach W-2 or W-2P to face of this return) .
27 Renter's credit—if you lived in rented property on March 1, 1975, complete Part 1 on page 2
28 1975 California estimated tax payments . . . toe. OF 28.
29° Excess California SBI tax withheld (attach Form DE 1964 t to face of this return) . rn | o
30 Total prepayment credits (add lines 26 thru 29) a .
31 If line 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero.
Pay in full and mail with return to: FRANCHISE TAX BOARD mre PAY IN FULL ——> 3)
SACRAMENTO, CA 95867 : .

32 If line 25 is smailer than line 30, enter amount OVERPAID

‘33° Amount of line 32 to be REFUNDED TO YOU. Atlow at least six “weeks,

Mail return to: FRANCHISE TAX BOARD
P.O. BOX 13-540

SACRAMENTO, CA 95813 ri

34 Amount of line 32 10 be credited on your 1976 ESTIMATED TAX. Ee | <—— ESTIMATED TAX} R

Under penalties of perjury, | declare that | hove examined this return, including accompanying schedules and statements, and to the best of my knowledge ond
belief it is true, correct and complete. If prepared by a person other than taxpayer, his declaration is based on all information of which he has any knowledge.

z SIGN or signature . Date - 7 P Scary Signature (other than taxnayer) : Date .
7 HERE eT signature—if a4d Joint return Date : a Address (and Zip cole) "36 2: 3 v859

Do not write in these spaces

ATTACH FORM DE 1964 HERE
Write social security number on check or money order. ATTACH HERE »

nw 88326 Docid:32#745555 Page

+ Page 2 Form 540 (1975)

PART | — Renter's Credit — All questions must be answered

35 Did you, on March 1, 1975, live in rented property which was your principal residence? . . . . (© Yes Sh Wo If no, you may not claim this credit
36 Was the property you rented exempt from property tax? . . . . - oe oe wees 6D Yes O-No if yes, you may not claim this credit
37 “Did you tive with any other person who claimed you as a dependent for i income tax purposes? . . OG Yes “(No If yes, you may not claim this credit

38 Did you or your spouse claim the homeowners’ property tax exemption or receive public assistance? (J Yes O No If yes, see page 6 of instructions

PART Ii — Other Income : . ; . J

39 Business income (or loss) (attach Schedule C(540}) ~

: 40 Net gain (or loss) from sale or exchange of capital assets fattach Schedule 01540) )

| 41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D- 115400)
: 42 Pensions and annuities

:; 43° Rents and royalties . curnuce el A
: = SCHED

A 44 Partnerships . . 1. FORM (540) I Peete ec cn Pree n eee
4 45 Estates and trusts . . . yd [eee ereeeeeeeee Stree

46 farm income (or loss) (attach Schedule F(540) }

47 Miscellaneous income ~

~ (a) Fully taxable pensions and annuities (not reported on Schedule £(540) )

(b) Alimony . Loe

(c) Other (state nature and SOUICE) eee sevoeesenssoneenneesnceneeeneeeeauteeenesouseese
Enter total of lines 47(a), 47(b), and 47(c)

Total (add lines 39 thru 47).

Fr PART ‘ll — Adjustments to Income

49 “Sick pay,” if included in line 10 (see instructions — attach statement)

: 50 Moving expenses (see instructions —- attach statement)

4 51 Employee business expenses (see instructions — attach, statement)

z 52 Military exclusion (see instructions) . .

A §3 Payment as a self-employed person to a retirement plan, etc. (see instructions)
4 54 Forfeited interest penalty (see instructions) Lo

, 55 Totat adjustments (add lines 49 thru 54). Enter here and on line 15

Enter here and on line 13°.

PART IV — Itemized Deductions —

@ Attach Schedule A(540) and enter sub-totals on lines 56 thru 61, below
_ 56 Total deductible medical and dental expenses (from Schedule A(540), line 10)
- _ 57 Total child adoption expenses (from Schedule A(540), tine 13)
;| 58 Total taxes (from Schedule A(540), line 20)
4 59 Total interest expense (from Schedule A(540), line 23)
+ 60 Total contributions (from Schedule Al540), line 28)
61 Total miscellaneous deductions (from Schedule A(540), line 39)
62 Total itemized deductions (add lines 56 thru 61). Enter here and on line 17

i PART V — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW.

63 “Other State’ net income tax credit (attach copy of other state return and Schedule $(540)) toe ee ee ee y
64 Retirement income credit (attach Schedule RIS40)) . 2... ®

65 TOTAL (add lines 63 and 64).

Enter here and on line 22

NW 88326 Docld:32245535 Page 44

|
|
|

on Form 540

Name as show!

or $4,000 or less and your filing status is ‘‘Single,”
table box.

Medical and dental expenses (not compensated by insurance or otherwise) for
medicine and drugs, doctors, dentists, nurses,
hospital care, insurance premiums for medical
care, etc.

=~

. One half (but not more than $150} of insurance
premiums for medical care................ Doce ee ee

. Medicine and drugs. 2.000... 0... ccc eee
. Enter 1% of line 16, Form 540......... ena L

. Subtract line 3 from line 2. Enter difference (if less
than zero, enter zero)... 6... .

Plow Nn

5. Enter balance of insurance premiums for medical care
not entered on line Loo... eee

6. Other medica! and dental expenses: ~
“ (a) Doctors, dentists, nurses, etc.......... rn
(b} Hospitals
(c) Other (itemize)... nee eeencseecceceseeceencersnesecneenscemeesnere

9. Subtract line 8 from line 7. Enter difference (if less
than -zero, @nter zero).....................00. .

10. Total—(Add lines 1 and 9. Enter here and Q

Form
540, line 56)......... :

Child Adoption Expense

11. Total expenses paid or incurred—Attach itemized list
12. Enter 3% of line 16, Form 540..................
13. Subtract line 12 from line 11—See instructions for

maximum limitations. (Enter here ‘and on Form 540,
line 57). eee eee

Taxes
14. Real estate.....00.0 0.0.2 eee
15, State and local gasoline
16. General Sales...... cece eevee eee .
17. Auto license—Excess of registration and weight fees
(see instructions)...................0.0220 2000
18. Personal property (Boat and Aircraf)..............
19. Other (itemize)

20, Total taxes—(Add lines 14 thru 19. “Enter here and
on Form 540, line 58)............0..000.0c eee

NW 88326. Docld:32245535 Page 45

» CALIFORNIA
ITEMIZED DEDUCTIONS

Attach to Form 540

It your adjusted gross income is $8,000 or less and your ning status is “Married, Filing Taint.” “f 4d of Household,” or ‘“Widow(er) With Dependent Child,”
‘Married, Filing Separately,” do not itemize, enter zero on Form $40, line 23, and check the tax

USE ONLY IF YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEOUCTION

30. Insurance

31. Subtract line 30 from line 29. Enter difference (if line

Social Security N Number,

Interest Expense

21, Home mortgage... eee
22. Other (itemize)

23. Total—tAdd lines .21 and 22. Enter here and on
Form 540, line 59).

Contributions

24. Cash contributions for which you have receipts,
canceled checks, etc......... bec e ete tees

25. Other cash contributions. List donees and amounts

tet

26. Other than cash.—See instructions for required state-
ment ....... Tc cece teeter eens

27. Carryover from 1974—See instructions.......... ,
28. Total—{Add lines 24, 25, 26, and 27. Maximum de-

duction may not exceed 20% of adjusted gross
income. Enter here and on Form 540, fine 60)......

Miscellaneous Deductions

Casualty or Theft Loss(es)—See instructions _

NOTE: If you had more than -one loss, omit lines 29
through 33 and follow instructions for guidance.

29. Loss before insurance reimbursement.............. :
reimbursement.................-6. an

30 is greater than line 29, enter zeto)............
32. Enter $100 or amount on line 31, whichever is smaller
33. Casualty or theft loss (line 31 less fine 32)........
34. Alimony paid... eee
35. Child care—See instructions. wees
36. Union dues... coves tees
37. Employment education expense—See instructions... .
38. Other—litemize) cent nee a

39. Total—Add lines 33, 34, 35, 36, 37, and 38.

J (Enter
- here and on Form 540, line 61) :

@ cron rs

_ PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION = |v

(Sole Proprietorships)

po . . :
vt : Attach this schedule to your Income tax turn, Form 540 or S40NR — Partnerships, joint ventures, ete., most file on Form 565
i Name as shown on Form 540 or 540NR ff y ; y) : : Soclal Security Number
, AMue Le PV¥eLts Aub | 322-/2-79797
1A. Name and Address of Business B. Federal Employer 1.0. No.
ivoprey BecrkoWerce Soe pega oe
: C. Principal business activity (i.e., retail-hardware; wholesale-tobacco; services-legal; etc.)_.--=>_1 aa
- D. Indicate method of accounting: O cash; oun: Ot cece ee ce cecnenenmnntrtenenenee
"£, Were Forms 591, 592, 596 and 599, for the cal -filed (if required)? ifyes 0 NO
F. Method of inventory valuation m__........ Ln LO...
Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
0 YES (NO If “Yes,” attach explanation. :
es 1 Gross receipts, sales, or fees $e Less returns and allowances §...............-. : a : Balance >
: 1 2 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation)........... Ce
‘ 3 Purchases $.... cesta Less cost of items withdrawn for personal US $_ou. oe. eceees eeepc: sd

LS 4 Cost of labor (do ‘hot include salary paid to Fousoll nee ee eee teen eee reer e Cet arte nena T —SY

“2 & Materials and supplies... 0.0.2... ccc eee eect cette ees Me cev eee Lee | —SY

4 6 Other costs (explain in Schedule C-2 or attach Schedule)............0..0. 00... eee ween ee  —sSY

: 7 Total of lines 2 thru Bocce cee eee bebe bbb bbb bbb et ben b een n ees concen e ae Cid oo :
8 Inventory at end of this year... eee peeves eee es : aon ‘ :

- 9 Cost of goods sold (subtract line 8 from line 7)........ 00.0 0. cecevcceeceeeceeeeevee ect eee ceeecees nace ett eee ee
. 10 Gross profit (subtract line 9 from fine once eee eens beeen eee ue ees lobe e eens
“14 Other income “(attach schedule). 0.2. eee eens re bocce ees cet e betes ce enes
"1 12 Total Income (add linés 10 and 11) ; ;
: ; . OTHER BUSINESS DEDUCTIONS :
* ‘13 Depreciation {explain in Schedule C-1 or attach Schedule)............ ee ee bebe nee ne
14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule). bbe e cen eee an TY
“ 15 Rent on business property... 00000. e tne e renee SY .
+ 1B Repairs (explain in Schedule C-2 or attach Schedule), 6. ............. Do ece ee nuns p vewbeves |
“: 17 Salaries and wages not included on line 4 (exciude any paid to yourself eee eee tect e eee es ae sd .
1B Insurance eee eee Cid
* 49 Legal and professional fees......... Ene EE nnn tert e tue teres id
20 Commissions 20.0. e et ete ake nee ees Meee Tr t—S
21 Amortization (attach statement)..................... re bed bbe bbb veee ved ebeeeees Sd
22 Retirement plans, etc. (other than your share, see instructions)......2.00 2202 ee
23 Interest on business indebtedness................-...0.-....04- eect edt eect ey be cb eee eeeees id
24 Bad debts arising from sales or services (Not applicable if reporting on cash basis)...................... Tr —SY
25 Depletion (attach schedule)... 00.0... tenes TCS
" 96 Other business expenses (explain in Schedule C-2 or attach Schedule)...................... cceeeeeeee Ld

"97 Totat of Hines 139 thru 260000 TM pg eens
a 28 Net profit (or loss) (subtract line 27 from line 12), Enter here and on Page 2, Form 540 or S40NR.... an Ce cn Sane AG G
Group and guideline class Date Cost or Depreciation Method of Life or Depreciation
int + . allowed (or allowable) computing :
or description of property Acquired other basis in prior years depreciation Rate . _ for this year

Schedule C-1
Depreciation
Claimed on line 13.

IN
i
NE

. ase * . A
Pe ts ae ee
gpa { ee ee
BBs ee
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a7 i ee

. ze
o2
m

NW 88326 Docid:32245535 Page 46

TAXABLE:

S975:

CAPITAL GAINS AND LOSSES

a . Attach to Form 540 or S40NR

Use this schedule to report gains and losses on stocks, bonds and similar investments,
and gains (but not losses) on personal assets such as a home or jewelry.

Name an on Form 540 or S40NR (/ i)
ANMUEL ’ Va.

<a 7 it

Social Security Number -

AB pz) 2992
PART I—Assets Held One Year or Less _ , 1 )

e. Cost or other hasis as
adjusted, cost of subse-
quent improvements (if
not purchased, attach
explanation) and = ex-

pense of sale.

b. Date acquired
(mo., day, yr.)

a. Kind of property and description

c. Date sold
(Exampie, 100 shaves of ''Z" Co.)

(mo., day, yr.)

é. Gross sales.

¢..Gain or loss
price

Ad fesse) 7.

2. Enter gain (or loss), if applicable, “from line 18, ‘Schedule D-1 (540) (attach copy) .
3. Enter your share of net gain or loss from partnerships and fiduciaries .
4, Net gain or loss, combine lines 1, 2 and 3

PART il—Assets Held More Than One Year But Not More Than Five Years

6. Enter gain (or loss), if applicable, from line 20, Schedule D-1 (540) (attach copy) .
7. Enter your share of net gain or loss from partnerships and fiduciaries .
8. Net gain or loss, combine lines 5, 6 and 7

10. Enter gain (or loss), if applicable, from ‘line 22, Schedule D-1 (540) (attach copy) .
11. Enter your share of net gain or loss from partnerships and fiduciaries .
12. Net gain or loss, combine lines 9, 10 and 11

. Enter amount from line 4
14, Enter 65% of the amount on line 8
15, Enter 50% of the amount on line 12.
16. Enter unused capital loss carryover from preceding taxable years "(attach compotion
; 17. Combine the amounts shown on lines 13, 14, 15 and 16
* % 18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540. or ‘540NR

19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR the smallest of
-° (a) amount on lines 17;

(b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
of capital assets; or

fgseagt a husband or wife filing a separate return)

*, 10. If Section 18219 property:

“INW.88326,.Docld:32245535 Page 48

of 12. Enter amounts from lines 7(b), ach), 9(d) ‘and 10(4)

eggs te

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES |

(Sales or Exchanges Including Involuntary Conversions)
(Attach to Form 540, S40NR, 541 or 565)

Name as shown on Tax Return
MILE L-
PART | Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220

Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.
1._Description of Sections 18211, 18212-18, 18219, and 18220 property. (mo tay 9)

JAN! WOOP LES. BISTRO... COFFE Kee wt MEOF. 2S.

Correlate lines 1(A) through 1(D) with these columns ——= > Property = Property 7

Gross sales price :

Cost or other basis and expense of sale

Depreciation allowed (or allowable) .

Adjusted basis, line 3 less line 4

Total gain, subtract line 5 from line 2

If Section 18211 property:

(a) Depreciation allowed (or allowable) after applicable date.
(See Instruction D-3)

(b) Line 6 or line 7(a), whichever is smaller

8. If Section 18212-18 property:

(a) Enter additional depreciation after 12-31-63 and before
1-1-71 .

(b) Enter additional depreciation after 12. 31 70 :

(c) Enter line 6 or line 8(b), whichever is smaller .

(d) Line 8(c) times applicable percentage (Instruction D-4) .

(e) Enter excess, if any, of line 6 over line 8(b)

(f) Enter line 8(a) or line 8(e), whichever is smaller .

NS ae wn

(g) Line 8(f} times applicable percentage (Instruction D-4)
(h) Add line 8(d) and line 8(g) toe ee
9. If Section 18220 property: .
(a) If farm land, enter soil and, water conservation expenses
for current year and four preceding years .
(b) If farm property, other than land, subtract line 7(b) from
- line 6; OR, if farm.tand, enter line 6 or fine 9(a), which-
ever is smaller (see Instruction D-5)
(c) Excess deductions account (see Instruction D-5)
(d) Enter line 9(b) or line 9(c), whichever is smaller .

(a) Soil and water conservation expenses made after 12-31-69

(b) Enter amount from line 9(d), if any; otherwise, enter a zero

(c) Enter excess; if any, of line 10{a) over 10(b) _.

(d) Line 10(c) times applicable percentage (Instruction D-5)

(e) Line 6 less line 10(b) 2...

(f) Enter smaller of line 10(d) or line 10(e) os - .
SUMMARY OF PART | (Complete Property Columns TA) through (D) up to Line 10(f) before going to Line 11) '
11. Enter amounts from line 6 . 5

13. - Subtract line 12 from line 11, enter here and in appropriate
Section in Part Il (see Instruction D-2) Coe eee
14. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part til


7

' Schedule D-1(540)

“+ PART Il Sales or Exchanges of Property Used in Trade or Business and/or Involuntary Conversions
_ (Section 18181-82) see Instruction E

‘Section A— INVOLUNTARY CONVERSIONS DUE TO CASUALTY AND THEFT

f, Cast or other basis, cost of
subsequent improvements
(if not purchased,
attach explanation) and
expense of sale

a. Kind of property (if necessary,
attach statement of descriptive
details not shown below)

e Depreciation al allowed
(or aliowable)
since acquisition

g. Gain (or toss)
(4, plus e. less f.)-

c. Date sold
(mo., day. yr.)

b. Date acquired

d. Gross sates
(mo., day, yr.) price .

16, Combine the amounts on line 15, enter here and also on the appropriate , line as follows
(a) For all returns, except partnership returns: (1) {f line 16 is zero or a gain, enter amount of each gain or- loss, above, in. -
column (g) of applicable Section B-1, B-2 or B-3; (2) If line 16 is a loss, enter such amount on line 25 of Part Il,
(b) For partnership returns: Enter gain(s) and loss(es) in Schedule K (Form 565). See Instruction E.
Section B-— SALES OR EXCHANGES OF PROPERTY USED IN TRADE OR BUSINESS AND CERTAIN INVOLUNTARY CONVERSIONS
(Net Reportable in Section A)

Section B-1 Property Held One Year or Less

. Combine the amounts on line 21, enter here .

& ° -23. Combine the amounts on lines 18, 20 and 22; enter here and also on the ‘oppropriate line ds follows
(a) For all returns, except partnership returns: (1) If line 23 is a gain, enter the amounts from lines 18, 20 and 22, on lines 2, 6

"and 10, respectively, of the Schedule D (Form 540), or if filing Form 541, enter amounts from lines 18, 20 and 22, on lines.

2, 7 and 11, respectively, of the Schedule D (Form 541). (2) If line 23 is a loss, enter such amount on line 26 of Part Wh

(b) For partnership returns: Enter amounts on lines 18, 20 and 22, in Schedule K(565)—see Instruction. E. ;
PART 11 Ordinary Gains and Losses ,

a

a. Kind of property and how
' acquired (if necessary,
J attach statement of descriptive
details not shown below)

{. Cost or other basis, cost of
subsequent improvements
and expense of sale

e. Depreciation allowed
(or allowable)
since acquisition

b. Date acquired
(mo., day, yr.)

c. Date sold

d. Gross sales
(mo., day, yr.) i

0: Gain (or loss) *
price

(Cd, plus e. less f.)

. Gain, if any, from line 14
25. Loss, if any, from line 16
. Loss, if any, from line 23

28. Combine lines 24 through 27, enter here and also on the appropriate line as follows .
. (a) For fiduciary and partnership returns: Enter the gain (or loss) shown on fine 28 on the line provided for on ‘the
oe return being filed—see Instruction F for specific line reference.
: (b) For individual returns:
: (1) If the gain (or loss) on line 2B includes losses which are to be treated. as an itemized deduction on
. ; : Schedule A (Form 540 or 540NR) (see Instruction F), enter the total of such loss(es). here and on-
” Schedule A (Form 540 or 540NR)—Identify as loss from line 28(b)(1), Schedule D-1. (Form 540)

A (2) Redetermine the gain (or loss) on line 28, excluding the loss (if any) entered on line 28(b)(1). Enter here
q 2 f F 540 or F S40NR, under “Other | ie” oe ee .
“NW 88326~Bocld: Sab ReMs Sai of Form r Form under er Incom

NAME .. SS) AY LL? tA Bip

te ee pes TN ee ee le pe eee AE Ca ef

PROSTHETIC APPLIANCES
HEARING AID

Ge AMBULANCE
LABORATORIES

CASUALTY OR THEFT (LOSS(ES)

7 CSSC~*S

29 TOT.CAS.OR THEFTLOSS >

CALENDAR YEAR 19 2S”
"ADDRESS 22 — /2-? ____ soc. sec. No. .
-_ DEDUCTION SCHEDULE i
, - MEDICAL. FEDERAL
: -,_2MEDICINE/DRUGS |} fata cas contnnnurions Xf __f_} ___
3 LESS 1% A.G.1, {Line 18 - 1040) |  J2ib PARTNERSHIP SHARE __. 0 Sn Os
4NET MED/DRUGS a __GIRL/80Y SCOUTS Y | J
| “BH &AINS. (% + EXCESS) a — HEART FUND/CANCERFUND ||
. _baor, | spenossuamreo rune ft 115-0
» or, ee ee ee
OR. S| |_| MISC. ORGANIZED cHanimies| TT
DR. fd 77 a
—— Jt-—-}+-—
| or: el i aan
1 OR. ; pT ns
: or, ae ns Cs Qs
. i [ [2orwentHancasy | CT CT
aa may Atel ae a Sl
‘ GbHOSPITAL 24 TOTAL CONTRIBUTIONS T FSa] [| (sn
5
SY
|
|
Td
, .

TRAVEL FOR MED.

NI}

MISCELLANEOUS DEDUCTIONS

MEDICARE INS.

30 ALIMONY j

GLASSES
7 MEDICAL EXPENSES |
LESS REIMBURSED BY INS.
‘| “BLESS 3% ADJ, GROSS INC.
. 9
1 +:% (TO $150) OF H & A INS.
10 TOTAL MEDICAL DED.
TAXES
11 STATE & LOCAL INCOME
12 REAL ESTATE
13 STATE & LOCAL GASOLINE
14 GENERAL SALES TAX

31 UNION/PROF ESSIONAL. DUES
32 CHILD & DEP. CARE {Form 2441)

INVEST. COUNSEL & PUBS. (Sched
EMPLOYMENT AGENCY FEES
SAFE DEPOSIT BOX

TEL. REQ. IN BUSINESS ;
POLITICAL CONTRIBUTIONS

:
=
a

LE )
BS PAD

:

i

hm

f\
y

6

15a PERSONAL PROPERTY

15b PERSONAL PROPERTY AUTO
16 SALES TAX AUTO

34 TOTAL MISC. DED.

| TOTAL TAXES
: INTEREST (TO WHOM PAID
“. “TBMORTGAGE

1
4

.

STATE

SUMMARY OF ITEMIZED DED.

TOT. DEDUCTIBLE MEDICAL & DENTAL
XPENSES {FROM LINE $0)

36 TOTAL TAXES (From LINE 17)
37 TOTAL INTEREST (Line 20)
38 TOTAL CONTR, (Line 24)

He |
hes
SERRSUERREMEEE

19 INSTALLMENT LOANS ja tsa.
i lteer|

39 CAS. & THEFT LOSS(ES) {Line29)

QQ TOTAL MISCELLANEOUS
DEDUCTIONS (FROM LINE 34)

Pit Ly
|
:
~

T,

_ Fe PES

ai TOTAL ITEMIZED DEDUCTIONS
ENTER ON FORM 1040 LINE 45

Ly ;
m
m
2
ke >
4

REMARKS

20 TOTAL INTEREST

*
‘

KJ
.
4

wr
:
:

Professional Stationers, 4
7180 bayiael ueytas
Neatly Hall geen, Gite

Inc.

. pg

sets

~NW 88326 Docld:32245535 Page 50

ah

2
5
3
an
S

SCHEDULE

- NW 88326 Docld:32245535 Page 51

© NAME,

“ ADORESS — 222- - >?

LINEN — ———_—

a oe . et tee . wei ote

” rd a cr es

L S s huey “cavewoae year 19 Ze

. 50C. SEC. NO.
FF

FISCAL YEAR ENDING
7 7

19

a

EDULE OF PROFIT OR LOSS FROM BUSINESS OR PRO STON
PRINCIPAL BUSINESS ACTIVITY . ;

BUSINESS NAME EMPLOYERS NO,

BUSINESS ADDRESS . . i

INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

I

TOTAL
LESS INVENTORY AT ENO OF YEAR

GROSS PROFIT

a

re

GROSS INCOME

en eee ert lt

OTHER BUSINESS DEDUCTIONS

“ADVERTISING

AUTO AND TRUCK EXPENSE

BAD DEBTS

COMMISSIONS

DELIVERY

a

DEPRECIATION ( SCHEDULE BELow )

DUES AND SURISCRIPTIONS

RR

ee

ENTERTAINMENT AND PROMOTIONAL

INSURANCE,

nn I

INTEREST
JANITOR AND HAUL ENG

LEGAL AND ACCOUNTING

OFFICE SUPPLIES AND EXPENSE

RENT

REPAIRS AND MAINTENANCE

SALARIES ANO WAGES

SUPPLIES

TAXES AND LICENSES

TAXES PAYROLL

TELEPHONE AND YTILITIES

CoN TRAC LALO

A

NET PROFIT or (LOSS ) FEDERAL RETURN

| P rs a
NET PROFIT OR (LOSS ) STATE RETURN - SEE DEPREC. SCHEDULE FOR DIFF. TAY sie aw) Van

SCHED! LE OF DEPRECIATION

YEARS COST OR PRIOR | SEPRECIATION
KIND AND LOCATION OF PROPERTY ACQUIRED METH. | OR % } OTHER BASIS a, DEPREC. THIS YEAR

2. Py SL IR 10328) —- __| 394

Tbe ES 7, 1 el od

PROFESSIONAL STATIONERS Inc FORM 104A
LOS ANGELES, CALIF.

SCHEDULE

fot

7 f p "i E EL ab fuses rts or 3 hu. ay * Calendar Yr. : ive
- SOC. SEC. NO. mee F/V/E 19__

_ GAINS ON INSTALLMENT SALES.

—) DESCRIPTION OF PROPERTY Ep (<a a ae SA OP |
3 DATE ACQUIRED : DATE SOLD Wel

TYPE OF ASSET: : CAPITAL | SEC. 1245 SEC. 1250 |
* 1, SELLING PRICE: CASH
2 NOTES
"3 MORTGAGE TRANSFERRED
C4 OTHER
Mtg. GROSS SALES PRICE (1+2+3+4)
;  _6. COST OR BASIS
4 7, LESS ACCUMULATED DEPRECIATION
8 PRIOR TO 1~—1-62
9. PRIOR TO 1-164
10. AFTER 12-31-61
io ST. LINE AFTER 12-31-63
12. EXCESS OVER S/L 1~64/12—69
13, EXCESS OVER S/L AFTER 12-31-69

14. ADJUSTED BASIS (6-7 THRU 13)
15. EXPENSES OF SALE
16. TOTAL ADJUSTED BASIS (14 + 15)
17. TOTAL GROSS PROFIT: (5 — 16}
18. TOTAL GROSS PROFIT — ORDINARY
19. TOTAL GROSS PROFIT ~ OTHER
1 20. CONTRACT PRICE (1 +2 + 4)
"24, GROSS PROFIT %
22. PAYMENTS RECEIVED YEAR OF SALE

23. CASH (1)

24. PRINCIPAL COLLECTIONS

25. EXCESS MORTGAGE OVER BASIS
26. OTHER (4)

27. TOTAL PAYMENTS (23 THRU 26)
- 28. RECOGNIZED GAIN

29. RECOGNIZED GAIN — ORDINARY

30. RECOGNIZED GAIN — OTHER

ORDINARY INCOME

TAX- TOTAL Go te
ABLE "PAYMENTS REPORTED
pa e —

ee

A

NW 88326 Docld:32245535 Page 52 we eee acerca

3
2K


ay i Acaaandbenisehiits, Shee

4040 . uUSs

the year January 1— December 31, 1974, or other taxable year ‘beginning . deeeeeeeeteceteseetaecaeeeteueeees
Name (If Joint return, os na

%&
For

and initials of both) COUNTY. OF

tte bE

Last name ..

Please print or type

Filing | Status (check only one)

” Married filing separately. If spouse is ‘also filing give

spouse's social security number in designated space above
and enter full

2
3
name here > oy

4. CO Unmarried Head of Household (See instructions on page 5)

S

you __”

mo
5 CL] Widow(er) with dependent child (Year spouse died» 19 )

‘Departinent of the Treasury—Internal Revenue Service

‘Individual Income Tax Return.

L974, ending ol cee eee eceeeees

RESIDENCE...

Exemptions Regular / 65 or over rf Blind - :
| 1 EJ Single 6a Yourself . i . Oo. | o Q
Married filing joint return (even if only one had income) b Spouse . . Ol -* C1 Checked pe

c First names of your dependent children who lived with,

iS SESE ULE DERR SEE

Your social security number -

BID 12-777

* Spouse’ 8 social security no.

8 Presidential Election

Enter
eee number >
d Number of other dependents (from line 027) « >
7 Total exemptions caine . oe ly
Do you wish to designate $1 of your taxes for this fund? . Noto: If you check the ‘*Ves"’
box(es). it -will not increase
It joint return, does your spouse wish to designate $1? : Tal Zi No'|

your: tax: or reduce your refund.

Campaign Fund. . >»
Attach Forms W-2. If unevail-

. 9 Wages, salaries, tips, and other employee compensation ane see instructions on page 3)
Seo Instructions

10a Dividends \on pages 6 and a) AZ... wees 10b ‘Less. exclusion $ BE. Balance >»
(it gross dividends and other ‘distributions are over $400, list in ban | of Schedule B.)

I" $400 or less, enter total without listing in Schedule B

il ° Interest income.

12. Income other, than wages, dividends, and interest (from | line 38) .
13 Total (add lines 9, 10c, 11, and 12) woe . .
14 Adjustments to income (such as “sick pay," moving expenses, etc. = from line 43) .

15

Subtract line 14 from line 13 (adjusted gross income) .

@ if.you. itemize deductions or line 15 is $10,000 or more, go to line 44 to figure tax. -

Please attach Copy B ‘of Forms W-2 here |

' Tax Rate Schedule X, Y, or Z™

Schedule G Seteile clon [Eoms7as Form 4726 |

Tax, check if from: | Tax Tables 1-12 |
Schedule D

a |.
5 17 Total credits (from line 54).
6 18 - Income tax (subtract line 17 ‘from line 16) :
~ |.19 Other taxes (from line 61) ute a
& |. 20 Total (add lines 18 and19). . . 2 we woe ee
oe a 7) ~ 21a Total Federal income tax withheld (attach Forms _
- 5 <> W+2 or W-2P to front) . 21a _ |G
Ee b 1974 estimated tax payments (include emount .
& |: allowed as credit from 1973 return)... —b_ __
” ¢ Amount paid with Form 4868, Application for Automatic {oo . vot a
fa Extension of Time to File U.S. Individual Income Tax Return c __
“- d@ Other payments (from line 65) . . 2. . 1. d

Total (add lines 21a, by c, and d)

22 : 23 = If line 20 is larger than line 22, enter BALANCE DUE IRS . me 4 _ . : -
© R= “ - > (Check here > GB , if Form 2210, Form 2210F, ‘or statement is attached. , See instructions on page 7) “
2a] 24 Ifline 22 is larger than line-20, enter amount OVERPAID ..

© | (25 Amount of line 24 to be REFUNDED TO YOU .

a ° Amount of line 24 to be cred-,

26

‘Piease attach Check or Money Order here] ,

ited on 1975 estimated tax. > |

NW 88326 Docid:32245535 Page 53

f over $400, enter total and list in Part Il of Schedule B] *

@ If you do not itemize deductions and line 15 is under $10,000, find tax in Tables and enter on line 16.

CAUTION. lf you have’ unearned income and can be claimed as a dependent on your parent's return, check fiere >] and see » instructions on peg: a7.

ee |

Y
dé id maki
Ve y order and make
Mp

ypu Wyle OE LG LL KG We EA (ee “tilde Mitel itil

Y . refiinded: (line 25), :
CMLL ID EL Ly Z

. Under penalties of perjury, # declare that | have examined this return, including accompanying schedules and statements, and to the best-of m
~ itis true, correct, and complete. Declaration of preparer {other than taxpayer) ts based'o ‘on all Information | of which F he has any knowledge.

43717 V VANOWE N STREET.
MAN NUYS, CA. 91405

|}

10c

mee

41

wy
Ny

1

{a4
15

w

Pay amount on line 23
in full with this return.
Write social security
number on, check or
payable to — Internal

eve: WH yy Yy : :

VL

\
i

WE

make, no entry 0 ‘ine 76.

7] Emp. Ident. or Soc. See. No. *
Ae BBRLOTE - :


NW 88326 Docld:32245535 Page 54

in.

Form 1040 (1974) . a + Page 2
tlt la Tn a SEINE nse
(a) NAME. , (b) Relationship () Months lived in your | (d) Did de- {e) Amount YOU | (f} Amount ~fur-'
. . me. If born or died pendent have furnished for de- | nished by OTHERS
. oO gus year, write B or D. income of | pendent’s sup- including Gepend-
. : . $750 or more? port. if 100% ent.
* . . write ALL.

Me BL :

Other
Dependents

27 Total number of dependents listed in column (a). Enter here and on line 6d .

28

28 Business income or (loss) (attach ScheduleC) . . 2°. 1 ee 3 ee es
29 Net gain or (loss) from sale or exchange of capital assets (attach Schedule D) . ee ee
30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) .
31 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (aitach Schedule E) .
32 Farm income or (loss) (attach Schedule F) . . . . . . w . .
33 Fully taxable pensions and annuities (not reported on Schedule E—see i instructions on 1 page 8)
. 34 50% of capital gain distributions (not reported on Schedule D—see instructions on page 8) -
35 State income tax refunds (iat tt thae edt yon ‘page 8).
36 Alimony received . . . oboe ee tke ew ee
37 Other (state nature and s source—see instructions on page 8) > :

Eel

38
Adjustments to income

39 ‘Sick pay.’’ (From Forms W-2 and W-2P. If not shown on Forms W-2 or W-2P, attach Form 2440 or statement.) 39

40 Moving expense (attach Form 3903) . . . . . a
41 Employee business expense (attach Form 2106 or statement) tee a , | 4r
42 Payments as a self-employed person to a retirement plan, etc-—see instructions on page 9 . 42
43 Total adjustments (add lines 39, 40, 41, and 42). Enter here andon line 14...) 43
Tax Computation (Do not use this part if you use Tax Tables 1-12 to find your tax.)
44 Adjusted gross income (from line 15) . 9. . woe a | 44
45 (a) If you itemize deductions, check here & (J and enter ‘total from Schedule A, line 41 ) ©
, and attach Schedule A. a se ee . | 45
(b) - ff you do not itemize deductions, check here > c and enter 15% of line 44, but do an es
NOT enter more than $2,000. ($1,000 if tine 3 checked) wee .
46 Subtract line 45 from line 44. . . . eee . kee ee te | 46
47 Multiply total number of exemptions claimed on line z, by $750 eee ee ke ee 47
48 Taxable income. Subtract line 47 from line 46... rr 1)

(Figure your tax on the amount on line 48 by using Tax Rate Schedule X, Y, or Z, or if applicable, th the alternative -
tax from Schedule D, income averaging from Schedule &, or maximum tax from Form 4726.) Enter tax on line 16. -

Genes Credits

49 Retirement income credit (attach ScheduleR) . 2. ee ee ee ee
50 Investment credit (attach Form 3468) . . . . . a woe eee
51 Foreign tax credit (attach Form 1116) . . . . . on ee ee ke 4
§2 Credit for contributions to candidates for public office—see instructions on page9 .

53-Work Incentive (WIN) credit (attach Form 4874) °°. . . woe oe
54 Total credits (add lines 49, 50, 51, 52, and 153). Enter here and on ‘line 17 .

Other Taxes

55 Self-employment tax (attach Schedule SE)
56 Tax from recomputing prior-year investment credit (attach Form 55) ak eae
57 Tax from recomputing prior-year Work Incentive (WIN) credit’ (attach schedule) . ae
58 Minimum tax. Check here & [], if Form 4625 is attached. 2. 6. - 1 ee ee

§9 Social security tax on tip income not reported to. employer (attach Form 4137): .

60 Uncollected employee’ social security tax on tips (from Forms W-2) . . -. soe

61 Total (add lines 85, 56, 57, 58, 59, and 60). Enter here and online 19 .
: Other “Payments ; il .

62 Excess FICA tax withheld (two or more employers—see instructions on page 9)

63 Credit for Federal tax on special fucts, nonhighway gasoline and lubricating oil (attach Form 4136) . -

64 Credit from a Regulated investment Company (attach Form 2439)... . . . .
65 Total (add lines 62, 63, and 64). Enter here and on line 2ld. . .
2 | Did you, at any time during the taxabie year, have any interest in or signature © or other authority over -

A>) © | a bank, securities, or other financial account in a foreign country (except | ina U. ‘Ss. military banking
& 8 facility operated by a U.S. financial institution)? ©... .-. 0. 4% .- —_ toe .
“ = | If “Yes,” attach Form 4683. (For definitions, see Form A683. } : : -

a : ue te U.S, GOVERNMENT PRINTING OFFICE ; 1974--O-548-047

“+-


AAP ia Terenas ae SRR Ta aa sitinid * RES ia PHD

Schedules AxB—Itemized Deductions AND

(Form 1040) . Dividend and Interest Income
cee tevenen Serace” b> Attach to Form 1040. p> See Instructions for Schedules A and B (Form 1040).

Internal Revenue Service

Name(s). as shown on Form ‘104
SAMUEL £.

‘Medical and Dental Expenses (not compensated by insurance
or otherwise) (See instructions on page 10.)

1 One half (but not more than $150) of
insurance premiums for medical care.
(Be sure to include in line 10 below)

2 Medicine and drugs
3 Enter. 1% of line 15, Form 1040

_ 21 a Cash contributions for which you |
have receipts, cancelled checks,. etc.

b Other cash contributions. List
donees and amounts. »_____

4 Subtract fine 3 from line 2. Enter dif--
ference (if less than zero, enter zero) .

5 Enter balance of insurance premiums
for medical care not entered on line 1’.
6 Enter other medical and dental expenses: ne A ean

a Doctors, dentists, nurses, etc. 22 Other than cash (see instructions on
b Hospitals . oe -. page 11 for required statement)
¢ Other (Itemize—include ‘hearing aids, 23 Carryover from prior years
dentures, eyeglasses, transportation, 24 Total contributions (add lines 21a, b , LIA
ete.) Pee eel Lo 22, and 23). Enter here and on line 38 . /
‘ ; ; Casualty or Theft Loss(es) (See instructions on page 12) ;
Note: If you had more than one loss, omit lines 25 through —__
28 and see instructions on page 12 for guidance.

Loss before insurance reimbursement .

26 Insurance reimbursement

27 Subtract line 26 from line ‘25. Enter
difference Cf less than _-20F0, enter
zero) . . -

28 Enter $100 or amount on line 27, :
whichever is smaller. . . _

29 Casuaity or theft loss (subtract line 28
_from line 27). Enter here and on line 39 Lani

7 Total (add fines 4, 5, 6a, b, and c)
8 Enter 3% of line 15, Form 1040.

9 Subtract line 8 from line 7 it less than
zero, enter zero)

10 Total (add lines 1 and d 9). Enter here {
and online 35... . >

Taxes (See instructions © on page 10)

30 Alimony paid
31 Union dues .

11 State and loca! income

12 Real. estate

13 State and local gasoline (see gas tax tables)

14 General sales (see sales tax tables)

15 Personal! property: . . . :
16 Other (itemize) P ooo

32 Expenses for child and dependent c care
services (attach Form 2441) .

17 Total (add lines 11, 12, 13, 14, 15, and 34 Total (add lines 30, 31, 32, and 33).
16). Enter here and online 36. Enterhereandonline40. . . . >

Interest Expense (See instructions on rage 11.) Summary of Itemized Deductions A

18 Home mortgage .
19 Other (Itemize) » 35 Total medical and dental—line 10.

: 36 Total taxes—line 17

37 Total interest-—line 20

38 Total contributions—line 24 ..

39 Casualty or theft loss(es)—line 29.

40 Total ‘miscellaneous—line 34

aL Total deductions (add lines 35, 36, 37,
. 38, 39, and 40). Enter here and on S90.

Form 1040, line 45

20 Total (add lines 18 and 19). Enter here 24 9
and online 37...

‘ 16—-R9291—1

_ NW 88326 Dockd:32245535 Page 55

aE Uy hat Ta esr eS

(ARAL EE SAAT RISER, FUL be

Profit or (Loss) From Business or Profession
(Sole Proprietorship)

fot the Treasury Partnerships, Joint Ventures, etc., Must File Form 1065.
Revenue Service Pm Attach to Form 1040. p> See Instructions for Schedule C (Form 1040)._

y Name(s) as mS on Form “LP
A Principal business > a. (see oe C1n
B Business name Pm. Wo Ob Le

ao
stryctions) b>. KNERVICE .... > product ef am
YY PIT s Co FFEES HOE Employer identification number
D Business address (number and street) B >. 60 OLS AB

GM TRG 7-1 Oy,
City, State and ZIP code m.. AICS (6. =.

_ E Indicate method of accounting: “Q (C] Cash (2) 5 Accrual (3) oO Other >
F Were you required to file Form W-3 or Form 1096 for 1974? (See Schedule C Instructions.) . . .
If “Yes,” where filed ce eee nee tne ete rence suena es coe eeee cee cee ee eeneedeeeneneceeeeumeaeeeneeeeeeee
G Was an Employer's Quarterly Federal Tax Return, Form om 8 for this business for any quarter in 1974? . a

H_ Method of inventory valuation Dr. cee ee secetessceseeseseevareneeceteetsnees . Was there any substantial change in
the manner of determining quantities, costs, or valuations between the ‘opening and closing inventories? (if “Yes,” attach explanation) .

1 Gross receipts or sales $ ) oo... Less: returns and allowances $....... eeueeaseesesitscereteneel : Balance >
" 2 Less: Cost of goods sold and/or operations (Schedule C-1, line 8) : ¥
.3 Gross profit . 7
4 Other income (attach ‘schedule
5 Total income (add lines 3 and 4)
6 Depreciation (explain in Schedule C-3) oo
Taxes on business and business property (explain in Schedule C-2) .

Income

Rent on business property)... 6. ee

Repairs (explain in Schedule C—2) . . oo

10 Salaries and wages not included on line 3, Schedule eC-l (exclude a any paid to yourself) a

Al Insurance © ee ye

12 Legal and professional fees. oe ee Peeceeencneeee : 7

13 Commissions . . * Ce .. weeceeseece ee

14 Amortization (attach statement) Soe bo . . —_

15 (a) Pension and profit- -sharing plans (see Schedule C instructions)
(b) Employee benefit programs (see Schedule C Instructions) .

16 Interest on business indebtedness .

17 Bad debts arising from sales or services
Depletion . :

19 Other business expenses (specify):

oon

Deductions
Lol
ao

(k) Total other business expenses (add lines 19(a) *hroveh 1
20 Total deductions (add lines 6 through 19) .

21 Net profit or (loss) (subtract line 20 from tine 5). Enter here and on Form 1040, line 28. ALSO | q BY
enter on Schedule SE, line 5(a) ._.. .
SCHEDULE C—1.—Cost of Goods Sold ‘and/or Operations See Schedule C Tastructions for Line 2)

1 Inventory at beginning of year (if different from last year's closing inventory, attach explanation) .

Purchases $..........------2:teseeses Less: cost of items withdrawn for personal use $.......--.--..--= ’ Balance >
Cost of labor (do not include salary paid to yourself) . ee ot

Materials and supplies .

Other costs (attach schedule)

Total of lines 1 through 5 ;

Less:. Inventory at end of year Pa won
Cost of goods solid and/or operations. Enter here and on line "2 above .

and

NOU hRWN

NW 88326 Docld:32245535 Page 56


oi

SNe STCIET SRNETER 20 AED BEA PRN

Schedule C (Form 1040) 1974

":.  * SCHEDULE C-2.—Explanation of Lines 7 and 9
ee Line No. ~

Explanation

Explanation

SCHEDULE C—3.—Depreciation (See Schedule C Instructions for Line 6) If you need more space, you may use Form 4562. . .

, Note: if depreciation is computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, or the Guideline . ‘

. Ciass Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Lite (ADR) System) or Form 5006
yo . (Guideline Class Life System). Except as otherwise expressly provided in income tax regulations sections 1.167(a)—11(b)(5)(vi) and 1.167
(a)-12, the provisions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970. (See

Publication 534.) So

Check box if you made an election this taxable year to use ["] Class Life (ADR) System and/or ["] Guideline Class Life System.

. sors d. Depreciation e. Method of . . . oe a
a. Group and guideline class b. Date c. Cost or allowed me allowable * “computing f. Life or . g. Depreciation for...
or description of property acquired other basis in prior years depreciation rate this year: |”

Total additional first-year depreciation (do not include in items below) \_

Sepeaton rm romaooe C8).

ek WNP

Other depreciation:
7 Buildings. . 2 2
oo "Furniture and fixtures
Transportation equipment -_
Machinery and other equipment .
Other (specify)

5 Totals . . . . « « «
6 Less amount of depreciation claimed in Schedule C~1, page 1 °.
7 Balance—Enter here and on page l,line6. 2. 7 ww en
SCHEDULE C—4.—Expense Account Information (See Schedule C Instructions for Schedule C—4)

Name =: . Expense account Salaries and Wages

‘Enter information with regard to yourself and your five highest paid
employees. In determining the five highest paid employees, expense
account allowances must be added to their salaries and wages. How-
ever, the information need not be submitted for any employee for
whom the combined amount is less than $25,000, or for yourself if

. your expense account allowance plus line 21, page 1, ‘jis less than

es,’ $25,000,- : 7

: Did you claim a deduction for expenses connected with: ~ .

(1) Entertainment facility (boat, resort, ranch, ete.)?. . . (] Yes 19 (3) Employees’ families at conventions or meetings? .

(2) Living accommodations (exeept employees on business)? [] Yes No (4) Employee or family vacations not reported on Form W-2? (] Yes
. w us. GOVERNMENT PRINTING OFFICE : 1974—-O-548-050 oe .

Age h,

(988326 -Docld:32245535 Page 5T re


ae

SCHEDULE D Capital Gains and Losses (Examples of property to be reported on

~ (Form 1040) this Schedule are gains and losses on stocks, bonds, and similar investments, and gains (but ne EE
Department of the Treasury not losses) on personal assets such as a home or jewelry.) ay be
Internal Revenue Service » Attach to Form,1040. p> See instructions for Schedule D (Form 1040). e

Social security number

ee iy as hin py viata oe fee — Z . ‘ — oo ce aaah : 5 7 ;

mm Short- on Capital Gains and Losses—Assets Held Not More Than 6 Months

-@, Cost or other basis,

6. Date ¢t. Date

a. Kind of property and description Bs adjusted (see “f. Galn or (loss)
(Example, 100 shares of '‘Z'’ Co. acquired - - sold d. Gross sales ‘price instruction D) and "
) (Mo. day, yr.) | (Mo. day, yr.) instruction Da (d less 8)

1

2. Enter your share of net short-term gain or (loss) from partnerships and fiduciaries: soe 22
3 Enter net gain or (loss), combine lines 1 and 2 . °.) . eee ee . 3
4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction G) . 4a) | ¢

(b) Short-term capital loss carryover attributable to years beginning after 1969 (see | Instruction 9)
Net short-term gain or (loss), combine lines 3,.4(a) and (b) .. :

7 Capital gain distributions . . . | : re Soe se ne
8 Enter gain, if applicable, from Form 4797, line 4tay(a) (see Instruction A) ve ee - woe

9 . Enter your share of net long-term gain or (loss) from partnerships and fiduciaries. . ,

10 Enter your share of net long-term gain from small business corporations (Subchapter S) .

11 _Net gain or (loss), combine lines 6 through 10 _ , .

12(a) Long-term capital loss component carryover from years beginning before 1970 (see Instruction 6) .

(b) Long-term capital loss carryover attributable to years. beginning after 1969 (see Instruction G) .
bP 13 Net long-term gain or (loss), combine lines 11, 12(a) and 1 (b) ee oe

Fam Summary of Parts | and Il

t 14 Combine the amounts shown on lines 5 and 13, and enter the net gain or loss here ot
oreo) If line 14 shows a gain—
“ . (a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part V1 for computation | 154)
of alternative tax). Enter zero if there is a loss.or no entry on line 13. ~ 8 oe

. ' (b) Subtract line 15(a) from line 14. Enter here and on Form 1040, line 29 | rs
16 If line 14 shows a loss— _-
_& if losses are shown on BOTH lines 12(a) and 13; omit lines 16(a) a and (b) and go to Part IV,
See Instruction H. .. : a
& Otherwise, ot *
toy (a) Enter one of the following amounts: ‘ ,
4 (i) If amount on line 5 is zero or a net gain, enter 50% of amount on line’ 14;
co . (ii) If amount on line 13 is zero or a net gain, enter amount on line 14; or,
4 (iii) If amounts on line 5 and line 13 are net losses, enter amount on line 5. added to
50% of amount on “ine WY... we . oe

(b) Enter here and enter as a (loss) on Form 1040, line 29, the smallest of:

: (i) The amount on line 16(a); .

(ii) $1,000 ($500 if married and filing a separate return—if a loss is shown on line
3 “ 4(a) or 12(a), see instruction L for a higher limit not to exceed ($1, 000);, or
oo ; (iii) Taxable income, as adjusted (see Instruction K) .

- AG AAZB2—T

NW 88326 Docld:32245535 Page 58


NW 88326 Dochd:32245535 Page 59

oe NSE SS eit RES CaN a ey Ea Sa

“15 (a) Total “FICA" wages as indicated on Forms W-2 . . «> —= = a
(b) Unreported tips, if any, subject to FICA tax from Form 4137, line 9. le Is

SCHEDULE SE | Computation of Social Security Self-Employment Tax
(Form 1040) p> Each self-employed Person must file a Schedule SE. isi4
Department of the Treasury p> Attach to Form 1040. p> See instructions for Schedule SE (Form 1040).

Internat Revenue Service

@ If you had wages, including tips, of $13,200 or more that were subject to social security taxes, do not fill in this form.
@ if you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE."

Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.
NAME OF SELF-EMPLOYED PERSON (AS SHOWN (ON SOCIAL SECURITY CARD) Social security number of

Faye tts Kw Bo soltemployed person & | 3¥O | 1B: (YD o. ee
Business ‘Sctivities subject to self-e i= fe tax (grocery store, restaurant, farm, etc. ms A 2. a S -

@ If you have only farm income complete Parts | and I. @ If you have only nonfarm income complete Parts Il and Ul.
@ If you have both farm and nonfarm income coniplete Parts 1, Wl, and II.

SUIEER Computation of Net Earnings from FARM Self-Employment ws
A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method, oe
yne 2, if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines 1 and :
2 must be completed even if you elect to use th vot
REGULAR METHOD (a) Schedule F, tine 54 (cash method), or line 74 (accrual method). .
1 Net profit or (loss) from: | (b) Farm partnerships . . ... . -
2 Net earnings from farm self-employment (add lines 1(a) and (b)) cee
FARM OPTIONAL | (a) Not more than $2,400, enter two-thirds of the gross 5 profits eee,

3 If gross profits
from farming ' are: (b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 .

’ Gross ‘profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 ‘(accrual

Y
method), plus the distributive share of gross profits from farm partnerships (Schedule K-1 (Form 1065), line Yy Yj Y

15) as explained in instructions -for Schedule SE. LY Lila

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method .
Computation of Net Earnings from NONFARM Self-Emptoyment

(a) Schedule C, iine 21. (Enter combined amount if more than one business.) .

. (b) Partnerships, joint ventures, etc. (other than farming) : .

REGULAR METHOD (c) Service asa minister, member of a religious order, or a Christian Science prac-

tr

5 Net profit or _ titioner. (Include rental value of parsonage or rental allowance. furnished.) If
(loss) from: you filed Form 4361, check here [] and enter zero on this line . .
se {d) Service with a foreign government or international organization . . . . .

(See Form 1040 in Sous
(e} Other structions for line 37.) Specify Po. cee ee ane ee cee een eee nee

6 Total (add lines 5(a), (b), (c), (a), ana (@)) ee
7 Enter adjustments if any (attach statement) . . . . : : eee

8 Adjusted ‘net earnings or (loss) from nonfarm self- employment (line 6, as Js adjusted by line y.

If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9

through 11 and enter amount from line 8 on line 12(b), Part Whe

Note: You may use the nonfarm optional method (line 9 through line 11) only if tine 8 is less than $1, 600 and
less than two-thirds of your gross nonfarm profits,? and you had actual net earnings from self-employment of

$400 or more for at least 2 of the 3 following years: 1971, 1972, and 1973. The nonfarm optional method can

only be used for 5 taxable years.

* Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the distribu-
tive share of gross profits from nontarm partnerships (Schedule K-1 (Form 1065), line 15) as explained in
instructions for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (2), a as
adjusted by line 7.

NONFARM OPTIONAL METHOD
9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .
(b) Enter amount from line 3. (if you did not elect to use the farm optional method, enter zero.) .
(c) Balance (subtract line 9(b) from line Ma)) 2. 2 ee . coe eee ee
10 Enter two-thirds of gross nonfarm profits 7 or $1,600, whichever is , smaller eo. : se ee
11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller .
Computation of Social Security Self-Employment Tax

12 Net earnings or (loss): (a) From farming (from line 4) 2. . 64. we . : . we
(b) From nonfarm (from tine 8. or line 11, if you elect to use the Nonfarm Optional Method) . .
13 Total net earnings or (loss) from self-employment reported on line 12. ar line 13 is tess than $400,
you are not subject to self-employment tax. Do not fill in rest of form.) . woe : myo.
14 The largest amount of combined. wages and self-employment earnings subject to social secutty tax for 1974 is. ss tax for 1 : ___ $135,200 — 200 __06

(c) Total of tines 215(a) and (b) : :
16 Balance (subtract line 15(c) fromline 14). ... 2°: ee
17 Self-employment income—line 13 or 16, whichever is smaller ee eat
18 if tine 17 is $13,200, enter $1, 042.80; if less, multiply the amount on line 17 ‘by. 079 Lo ns

19 Railroad employee's and railroad employee representative’s adjustment from Form 4469, line 10
20 Self-employment tax (subtract line 19 trom line 18). Enter here and on Form 1040, line 55 .

tte U.S. GOVERNMENT PRINTING OFFICE 1 1974—-0-548-085 . So 16852943

RR St bt Sa EEN RI COT LE lA OMT TT

* (Form 1040)

“NW 88326 Docld:32245535. Page 60

"hoe

SCHEDULE SE.

Department of the Treasury
Internal Revenue Service

Pp Attach to Form 1040.

AEDT EERE AAR OI AERE RIE NENT MT OUTS TB NOR NED ANI EDIE TEAS

wo

’ Computation of Social Security Self- Employment Tax.

& Each self-employed person must file a Schedule SE.
b> See Instructions for Schedule SE (Form 1040).

@ |f you had wages, including tips, of $13,200 or more that were subject to social security taxes, do not fill in this form.
@ If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.

Important.——The self-cmployment income reported below will be credited to your social security record and used in figuring social security benefits.
SELF-EMPLOYED PERSO ;

NAME ©!

Social security number of
self-employed person >

‘AS SHOWN ON SOCIAL SECURITY CARD) -

Muek - Ma B Y .
Business activities subject to self- employmént tax (grocery store, restaurant, farm, etc.) DP» -

EIS TERRA HORNE DTT EN or

a

“ee

ikea

‘07 : |

he

Gat

@ If you have only farm income complete Parts | and IIH.

@ if a have both farm and nonfarm income complete Parts |, tl, and Ill.
Computation of Net Earnings from FARM Self-Employment

A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular “Method, =
line 2, if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines Land .

2 must be completed even if you elect to use the FARM OPTIONAL METHOD.

REGULAR METHOD

1 Net profit or (loss) from:

2 Net earnings from farm self-employment (add lines 1(a) and (b)) . . .
FARM OPTIONAL METHOD

3 if gross profits
from farming ' are:

' Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method), or line 72 ‘(accrual
method), plus the distributive share of gross profits from farm partnerships (Schedule K—1 (Form 1065), tine
15) as explained in instructions for Schedule SE.

4 Enter here and on line 12(a), the amount on line 2, or'line 3 if you elect the farm optional method . |

@ if you have only nonfarm income compiete Parts and WI.

| (a) Schedule F, “line 54 (cash method), or line 74 (accrual method). -
(b) Farm partnerships’)... wee et
(a) Not more than $2,400, enter two-thirds of the gross profits oe

(b) More than $2,400 and the net farm profit is less than $1,600, enter $1,600 .

|

Sy,81e Computation of Net Earnings from NONFARM Self-Employment

(a)

(b)

REGULAR METHOD] (c)
5 Net profit or
(loss) from:

(d)

(e)

Schedule C, iine 21. (Enter combined amount if more than one business.) .
Partnerships, joint ventures, etc. (other than farming)

Service as a minister, member of a religious order, or a Christian Science prac-
titioner. (Include rental value of parsonage or rental allowance furnished.) If
you filed Form 4361, check here [_] and enter zero on this line . ;
Service with a foreign. government or international organization woe ee , .

(Sea Form 1040
Other structions tor line 31) Specify > _:

6 Total (add: lines 5(a), (b), (c), (d), ana (€)) 2 ee
7 Enter adjustments if any (attach statement) . . . . Ale oa tae
8 Adjusted ' net earnings or (loss) from nonfarm self- employment (line 6, as 1s adjusted by line 2). .
If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9
through 11 and enter amount from line 8 on line 12(b), Part tt.
Note: You may use the nonfarm optional method (tine 9 through line 11) only if line B is less than $1,600 and
less than two-thirds of your gross nonfarm profits," and you had actual net earnings from self-employment of
$400 or more for at least 2 of the 3 following years: 1971, 1972, and 1973. The nonfarm optional method can
only be used for 5 taxable years.
? Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, plus the distribu-
tive share of gross profits from nonfarm partnerships (Schedule K~1 (Form 1065), line 15) as explained in
instructions for Schedule SE. Also, include gross profits from services reported on lines 5(c), (d), and (e), as

adjusted by line 7.

NONFARM OPTIONAL METHOD .
9 (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) .

(b) Enter amount from‘tine 3. (If you did not elect to use the. farm Optional method, enter zero.) .

(c) Balance (subtract line 9(b) from tine 9(a)) 26 ee

‘10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is smaller... soe ee
11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller .
Computation of Social Security Self-Employment Tax

- 4

12 Net earnings or (loss): (a) From farming (from line 4) . * ee ee ee a
‘(b) From nonfarm (from line 8, or line’11 if you elect to use the Nonfarm Optional Method) . ,

-13° Total net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400, .
you are not subject to self-employment tax. Do not fill in rest of form.) .  .

14 The largest amount of combined wages and self-employment earnings subject to social security tax for 1974 is...

15 (a) Total “FICA” wages as indicated on Forms W-2 . . ce
(b) Unreported tips, if any, subject to FICA tax from Form 4137, line 9.

(c) Total of fines 15(a) and (b) © 6 6 we ee
16 Balance (subtract line 15(c) from line 14)... «we : moa : , :
17 Self-employment income-—line 13 or 16, whichever is smaller woe eee ae

18 If line 17 is $13, 200, enter $1,042.80; if less, multiply the amount on line ‘V7 ‘by, 679 wie ve
19 Railroad employee’ s and railroad employee representative's adjustment from Form 4469, line 10°.

20 Self-employment tax (subtract line 19 trom line 18). Enter here and on Form 104

O, line 55...

_ Fv U.S. GOVERNMENT PRINTING OFFICE ; 1974—-O-548-055 . a

\

oe ls a

——o =

5 |

Eat 2

—w .
16-—-R3 234-1

angeney
Be

Departmant: of the Treasury
Internal Revenue Service

| Computation of Investment Credit

b> Attach to your tax return,

Identifying number 88 shown on
Page 1 of your tax return

1 Qualified investment in new and use
NOTE: Include your share of investm

d property. (See instructions C a

for eligible property.)
ent in property made by a Partnership,

estate, trust, smail business corporation, or lessor.

Type of Cost P oasis Applivabie Qualified GR uestment
Property Line - (See instruction Gj percentage Column 2 x column 3)
—_—u | ° . , ; +
~ (a) 3314 : *
New : "(by
==} ee seobeneend”
(©)
gg gf}
(d)
Used | a We tnteensereneeeneee
Property (0)

(See Instructions for
dollar limitation)

: on
7 or more

' 2 Total qualified investment—Add lines J(a) through 1(#). Boe ee
3 Tentative investment credit—7% of line 2 (4% for public utility property) ,
4 Carryback and Carryover of unused credit

¢ (s). (See instruction F and instructicn for fine 4—attach computation.) ,
5_Total—Add lines 3 and 4 a 2. :

: Limitation :
6 (a) Individuals—Enter amount from line 16, page 1,Form 1040 , , soe ee
(b) Estates and trusts—Enter amount from line 24 or 25, page 1, Form 1041
(c) Corporations—Enter amount from line 5, Schedule J 1 ye

+ Form 1120
7 Less: (a) Foreign tax credit hoe ee
(b) Retirement income credit (individuals only) :
(ce) Tax on lump-sum distributions. (See instruction 7.) 20. | .
8 Total—Add lines 7(a), (b), and,(c). 2. | |, Soe,
9 Line 6G less line 8 re
10 (a) Enter amount on line 9 or $25,000, whichever

is lesser, (Married persons filing separately,
trolled corporate groups, estates, and trusts,

con-
see instruction for line 10.) .

(b) If line 9.exceeds line 10(a), enter 50%

of the excess . °

"11 Total—Add lines 10(a) and (by

» whichever is lesser (enter here and on line 50,
© appropriate line on other returns) .
‘Schedule A

If any part of your investment in line 1. above was made by a Partnership,

estate, trust, small business Corporation, or lessor, complete the following: ° *
Name . / Property
(Partnership, estate, trust, etc.) Address

- New - Used Life years. }

16—~83298-1

Form 3468 as
_ NW'88326 Docld:32245535 Page 61 Lo as _ a * Te

Se Ra Bic (te arcs bee ee aes

NW 88326 Docld:32245535 Page 62 . _ . . . a

AA a EERE PRISER RS TO OT BERS PETE

Bee eye

Capital Loss Carryover

Form 4798 » (From 1973 to 1974)

Department of the Treasury ‘ » Attach to Form 1040.
Internal Revenue Service

Name(s) as shown on Form 10. . Social Security Number
HYtlei s 3 rid i?

A. Who Should File.—You will need to complete B. How to Compute Carryover.—if you have a capi-

either Part | or Part || of this form if you have a capital tal loss carryover, complete either Part | or Part Il of
this form, but do not complete both. :

loss to carry over to 1974.
1. Complete only Part | if lines 4(a) and 12(a) on ~
your 1973 Schedule D (Form 1040} DO NOT SHOW A

You will have a capital loss to carry to 1974 if the LOSS. . ee
amount on your 1973 Schedule D (Form 1040), line 2. Complete only Part Il if either (or both) line ~~
16(a), or line 33, is LARGER THAN the {oss deduct- 4(a) or line 12(a) on your 1973 Schedule. D (Form
ed on your 1973 Form 1040, line 29. 1040) shows a loss.

GEZEER Post-1969 Capital Loss Carryovers

Section A.—-Short-term Capital Loss Carryover

Enter loss shown on your 1973 Schedule D (Form 1040), line 5; if none, enter zero ane ignore *
lines 2 through 6—then go to line 7... , 1 { 2? Y ! ;

2 Enter gain shown on your 1973 Schedule D (Form 1040), line 13. r that tine is blank or “shows
aloss, enter a zero. 0 8

_

3 Reduce any loss on line 1 to the extent of any gain on line 2 . Ce

4 Enter amount shown on your 1973 Form 1040, line 29). 2... ww ee ee 4 [58 »)
5 Enter smallerofline30r4. 0.0. 1 eee 5 mom?)

6 Excess of amount on line 3 over amount on line5 2 we 6 (GehaD)

Note: The amount on line 6 is your short-term capital loss carryover fram 1973 to 1974 that is attributable to years beginning .
after 1969. Enter this amount on your 1974 Schedule D (Form 1040), line 4(b).

>: ee

i
N
<

rE a

POT I

Section B.—Long-term Capital Loss Carryover

7 Line 4 less line 5 (Note: If you ignored lines 2 through 6, enter amount from your 1973 Form

1040, line 29) . . coe toe ee ;
8 Enter loss from your 1973 Schedule D > (Form 1040), tine 213; if none, enter zero and ignore lines Va oot -
Q9 through 12... «. Ne 84] e: *
9 Enter gain shown on your 1973 Schedule D (Form 1040), ‘line 5. If that line is ‘blank or ‘shows - : ‘.
a loss, enter a zero Ca 9 —_—o9
can :
10 Reduce any loss on line 8 to the extent of anygainonlineQ 2 2 1 1 ww we ew we | dO ———} = >
| —o—

11 Multiply amount online 7by2 20. 20. ee woe ey. | a x,

12 Excess of line 10 over amount on line LL. 1 7. - . . , a2 es 0= a"

Note: The amount on line 12 is your long-term capital loss carryover from 1973 to igvat that is “attributable to years beginning
after 1969. Enter this amount on your 1974 Schedule D (Form 1040), line 12(b). oo oh

|

Form 4798 11974)

|

Form 4798 (1974)

ayia Pre-1970 and Post-1969 Capital Loss Carryovers

Section A.—-Short- term. ‘Capital Losses Identified

Enter loss shown on your 1973 Schedule D (Form 1040), line 5; if none, enter zero > and ignore
lines 2 through 20—then go to tine 21 :
- 2 Enter gain shown on your 1973 Schedule D (Form 1040), line 13. iW that line is blank or "shows

_

a loss enter a zero eof ee
3 Reduce loss on line 1 to the extent of any gain on line 2. an -
Note: /f line 4(a) on your 1973 Schedule D (Form 1040) is biank, IGNORE lines 4 through 1 11, enter
a zero on line 12-—then go to line 13.
4 Combine lines 3 and 11 on your 1973 Schedule D (Form 1040). Enter

the gain; or if zero or a loss, enter a zero... . 4
Note: If line 4 is zero IGNORE lines 5 through 11, enter on n line 12 the
loss from your 1973 Schedule D (Form 1040), line 4(a)—then go
to line 13.
Enter any gain from your 1973 Schedule D (Form 1040), line 3
Enter smaller of line 4or5 .

5
. _6_

Enter excess of gain on line 4 over line 6 Lo, : 7
_8_

9

on oou

Enter loss from your 1973 Schedule D (Form 1040), i line 12a); other-

wise, enter a zero so Soe eee

9 Reduce any gain on line 7 to the extent of any loss o on line 8. oe

10 Enter loss from your 1973 Schedule D (Form 1040), line 4(a); other-

. wise enter a zero. . a

11 Add the gains on lines 6 and 9 Loe ne : .. . (2d _
12 Reduce the loss on line 10 to the extent of any gain on line 11 .

: “13 Pre-1970 short-term capita! loss (Enter smalier of line 3 or 12) . .

14 Short-term capital loss attributable to years beginning after 1969 (excess of line 3 over line 13)

Section B.—Computation of Capital Loss Carryovers to 1974

15 Enter any loss from line 13,above 2 2... 1 ew “| as

16 Enter loss deducted on your 1973 Form 1040, line29. 2 2... {36 |
17 Loss carryover to 1974 (excess of line 15 over line 16—if line 15 does not exceed line 16, center
- zero). Enter here and on your 1974 Schedule D (Form 1040), .line “(a ;

18 Enter any loss from line 14, above . . ees me:
19 Enter excess of line 16 over line 15—if line 16 does. not t exceed line 15,
" entef zero 19

20 Loss carryover to 1974 (excess of line 18 0 over line 19-Lit line 18 does not exceed line 19, enter
’ zero). Enter here and on your 1974 Schedule D (Form 1040), line 4(b)
21 If you were required to complete Part IV of your 1973 Schedule D
(Form 1040), enter any loss from your 1973 Schedule D (Form 1040),
line 30; otherwise, enter zero... 21
22 Enter excess of line 19 over tine 18—if line ‘19 does not t exceed line
18, enter zero. (Note: if you ignored lines 2 through 20 above, enter .
amount from your 1973 Form 1040, line 29.). . . . 22 | 7 6
- 23 Loss carryover to 1974 (excess of line 21 over line 22—-if line 2 21 does not exceed line 22, enter
zero). Enter here and on 1974 Schedule D (Form 1040), line 12(a) :
24 If you were required to complete Part !V of your 1973 Schedule D (Form
1040), enter any loss from your 1973 Schedule D (Form 1040), line 31.
. However, if Part IV was not required, enter any joss from your 1973

Schedule D (Form 1040), line 13. 2 2 2. an 24
25 Enter excess of line 22 over line 21 _W.--  x 2 (if line. 22 does not
exceed line 21, enter zero.) . . . . os -|_ 25 -

26 Loss carryover to 1974 (excess of line 24 0 over r line 25—if line 2 24 does not exceed line 25, enter
zero). Enter here and on your 1974 Schedule D (Form 1040), line 12(b)

ty US. GOVERNMENT PRINTING OFFICE : 1974—-O-548-157 52-0761621

NW 88326 Docld:32245535 Page 63

17

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; : _ 19 _

FI SCAL” YEAR” ENDING". =

a

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SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION

PRINCIPAL BUSINESS ACTIVITY . :
BUSINESS NAME EMPLOYERS NO.

BUSINESS ADDRESS
TOTAL RECEIPTS

:

INVENTORY AT BEGINNING OF YEAR peo -t
MERCHANDISE PURCHASED 1:46077\ | vot
LABOR ee ae
es
ee
TOTAL (Ah079\| |
INVENTORY AT-END OF YEAR ; ‘ | €Oop | |35279

——— 7 .
GROSS INCOME : : | 32KOS |
8 . : : . OTHER BUSINESS DEDUCTIONS , .

ADVERTISING :
. AUTO AND TRUCK EXPENSE } f A. ‘ is ¢ °

BAD DEBTS

CASH SHORT
COMMISSIONS

=f
oll

DELIVERY

Ez —

DEPRECIATION ( SCHEDULE ATTACHED } ,
DUES AND SUBSCRIPTIONS

\

ENTERTAINMENT AND. PROMOTIONAL
INSURANCE

INTEREST |

JANETOR SERVICE

LAUNDRY

LEGAL AND ACCOUNTING

” MAINTENANCE = ‘

OFFICE SUPPLIES AND EXPENSE

RENT

REPAIRS

SALARIES AND WAGES we,
SALARIES OFFICERS . Bo

SUPPLIES
TAXES AND LICENSES

TAXES - PAYROLL

TELEPHONE
TRAVEL
UTILITIES .

PARKING _

NET PROFIT OR( LOSS ) - FEDERAL RETURN

“NET PROFIT OR LOSS ) ~- STATE RETURN ( SEE DEPREC, SCHEDULE FOR DIFF.

PROFESSIONAL STATIONERS INC. FORM 104

NW. 88826 “NBcid:33245535 Page 64.


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NW 88326. Docld:32245535 Page 65

PES ESTES I Ra ae EL

re RE ic LBS FAP SEES ERR FARIS SSE APNE SE Sa SEN BOSE TEE EE BA ST 2 SE DEER BES LEH SFE IS PERRET ay le ARETE EME Be EI EE IT ;

ce ESE as

2 INDIVIDUAL

CALIFORNIA

r RESIDENT

TAXABLE YEAR
ao

Spouse's Social Security Number

era /¥20

occu. | Yours Jf eS
A PATION Spouse's, =
EXEMPTION CREDITS If line 1 or 3 checked, enter $25 .

6 Personal (f line 2, 4 or 5 checked, enter $50

7 Dependents —- Do not list yourself, your spouse, or the person whu qualifies you
aii head of household. Enter name and relationship.

Artigas

ba INCOME TAX . :
“PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) For calendar year or
Enter social security number(s) only if incorrect or not shown on label. Taxable year ending. _., 197
NAME ( int return, give wa and initials of both) yy Your Social Security Number
AMGaEL Pu LLL K p 12-2! i PPP

PRESENT HOME ADDRESS (Number andrei, including apartment number, o

. b 2 é
R POST OFFICE, STATE AND, ZIP CODE

city, TOW
on AW AP

“FILING STATUS—Check Only One:
-. 10 Single
2 Married filing joint return (even if only one had income)

3 C) Separate return of married person—Enter spouse’s
* social security number and full name here

: Total Number > _ 2. 1. x $8
8 Blind (refer to instructions) Number of blind exemptions = x $8
5 (J Widower) with dependent child (Year spouse died » 197)| 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20

4 Oo Head of Household—Enter name of qualifying
_ individual

. 10 Wages, salaries, tips and other employee compensation { Agia Gory 2 of hormOd 2 ta tare af this}

) return. (f unavailable, attach explanation.

_ 11 Dividends—before federal exctusion. Enter total (if over $400, complete and attach Schedule B(540))
12 Interest. Enter total (if over $400, complete and attach Schedule B(540))

13° Income other than wages, dividends and interest (from line 48)

14 Total (add lines 10, 11, 12 and 13)

15 Adjustments to income (from line 54)

16 “Adjusted gross income {subtract line 15 from line 14)

+ If you do NOT itemize deductions AND line 16 is under $10,000, find tax in Tax Table and enter on line 19.
+ If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18. ,

17 Deductions: itemized (from fine 61) OR Standard ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 of 5 checked)
18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on line 19

19 Tax fram (check one) Tax Table (] Tax Rate Schedule ‘s Income Averaging Schedule (G or G-1) 0
20 Total axemption credits (from line 9, above) ol .

21 Tax liability (subtract line 20 from line 19-—if line 20 is greater ‘than line 19, ‘enter - ser0)

22° Other credits (from line 65—Includes special low income tax credit) -

23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, “enter ze10)
24 Tax on preference income (see instructions—attach Schedule Pt540)) a

25 Total tax liability (add lines 23 and 24) a

<@ ATTACH COPY 2 OF FORM W-2 HERE >

26 Total California income tax withheld (attach Form(s) W-2 or W-2P to face of this return)

27 Renter's credit—if you lived in rented property on March 1, 1974, complete Part 1 on page 2 .
28 1974 California estimated tax payments .

29° «Excess California SD! tax withheld (attach Form DE 1964 to face of this cefurn)

30 Total prepayment credits (add lines 26 thru 29).

= 31 If line 25 is larger than tine 30, enter BALANCE DUE. If it is equal to line 30, enter zero.

b 4 ; Pay in full and mail with retura to: FRANCHISE TAX BOARD ° PAY IN FULL aad

2 SACRAMENTO, CA 95867 ” not write in these spaces ans -
ow 32 If line 25. is smaller than line 30, enter amount OVERPAID Bo oe : .
= Mail return to: ; - FRANCHISE TAX BOARD =. | we el P82] ee Freep a
= P.0. BOX 13-540 m, E _

i ‘ ; SACRAMENTO, CA 95813 a ; ra

3 33 Amount of line 32 to be REFUNDED. (Allow at least six weeks) — —— REFUND TO YOU —» 33 .

E & 34 Amount of line 32 to be credited on your 1975 ESTIMATED TAX . . . | 34: Pe

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge ond
belief it is true, correct and complete. if # prepared by a persan other than taxpayer, his declaration is based on all information of which he has any knowledge. -

SIGN aT signature — : . Date do — sionatuve (other than taxpayer) Date

83717 VANOWEN STREE} 2

Write social security number on check or money order. ATTACH HERE

: v HERE rr signature—if filing a joint return : Date
NW 88226 Docid:32245535 Page 66 ,

Address (and Zip cod " . 94
re! an . ~ 967-34-8729


APSEDIESFRSSIR STEEL SRL UN RP PR RH FEE AEN LET ARENA TINA RSE REE BE SO ALTE SETS

et

Page 2 Form 540 (1974)

“PART | — Renter's Credit — All questions must be answered See Instructions, Page 3, for Allowable Credit. > |E.

-35 Did you, on March 1, 1974, live in rented property which was your principal residence? . . . . {) Yes MNo If mo, you may not claim this credit
35 Was the property you rented exempt from property tax? -. . te ee Yes CO No - If yes, you may not claim this credit
37 Did you live with any other person who claimed you as a dependent for income tax purposes? . . ([_) Yes (No -. If yes, you may not claim this credit .

38 Did you or your spouse claim the homeowners’ property tax ‘exemption or receive public assistance? (} Yes 1-1 No If yes, see page 3 of instructions _—

PART Il — Other Income

Busiriess income (or loss) (attach Schedule C(540))
40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule 1540))

41 Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D-1(540) )
Pensions and annuities

Rents and royalties . . | ATTACH

: ae SCHEDULE E

Partnerships . FORM (540)

Estates and trusts . t

Farm income (or toss) (attach Schedule F(540))

Miscellaneous income .

(a) Fully taxable pensions and annuities (not reported « on Schedule £(540)) - oe — Cow eee PATad oe - weneeereeeefeeee
(b) Atimony Le we
(c) Other (state nature and source)... senses ten ecene eee eet ecceeeerennctnelenne
Enter total of tines 47(a), 47(b), and 47(c). =, ;
48 Total (add lines 39 thru 47). Enter here and on line 13

_ PART Hl — Adjustments to Income

“Sick pay,” if included in line 10 (see instructions — attach statement)

50 Moving expenses (see instructions — attach statement)

51 Employee business expenses (see instructions — attach statement)
“52 Military exclusion (see instructions). . . . . a)
53 Payment as a self-employed person to a retirement plan, etc. , ,

54 Total adjustments {add lines 49 thru 53). Enter here and on line 15

ON SEPARATE RETURNS OF MARRIED TAXPAYERS, BOTH MUST ITEMIZE ~ po ae.
DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDUCTION. : _
© Attach Schedule A(540) and enter sub-totals on lines 55 thru 60, below coe : -
55 Total deductible medical and dental expenses (from Schedule A(540), line 10). tae an
56 Total child adoption expenses (from Schedule A(540), line 13)
-- 57 Total taxes (from Schedule A(540), line 21) a
Total interest expense (from Schedule A(540), line 25) . . . . . cs
59 Total contributions (from Schedule A(540), line 29) :
60 Total miscellaneous deductions (from Schedule A(540), line 40)
Total itemized deductions (add tines 55 thru 60). Enter here and on line 17

“seaeee

_ PART IV — Itemized Deductions —

PART ¥ — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW.

62 “Other State’ net income tax credit (attach copy of other state return and Schedule $(540) )
"63 Retirement income credit (attach Schedule R(540)) :

64 .(a) Special Low Income Tax Credit — If Adjusted Gross Income does not include net capital gains from assets held 1 more than a one
year and is $8,000 or less (joint return of married couple, head of household or widowler) with dependent child) or $4,000 or
tess (single or separate return of married person) enter the amount from: line 2l. It Adjusted. Gross Income includes Capital

; Gains, complete Schedule B-1. See Page 3 of Instructions :
“(b) Enter total here from line 4, Schedule B-!. If zero or a joss, enter zero...

65 TOTAL (add lines. ,62 thru 64a. Enter here and on tine 22

,

NW 88326 ‘Docid:32745535 Page 67


ee en eae ec a

e as shown on Form 540

ite Ll.

ATEMIZED DEDUCTIONS

Attach to Form 540

Use only it you do not use the Tax Table or take the standard deduction.

Medical and dental expenses (not comperisated by insurance or otherwise) for
medicine and drugs, doctors, dentists, nurses, hospi-
tal care, insurance premiums for medical care, etc.

10.

. Total—iAdd tines. 4 5, ‘6a, b, and c)

. Enter 3% ot adjusted Bross income shown on
Form 540 . toe

. One half (but not more than $150) of insurance

premiums for medical care

. Medicine and drugs

. Enter 1% | of adjusted gross income shown on Form
540. oh .

. Subtract line 3 from line 2. Enter difference (if tine

3 is greater than line 2, enter zero)

. Enter. balance of insurance premiums for medical

care not entered on line 1

. Other medical and dental expenses:

(a) Doctors, dentists, nurses, etc.
(b) Hospitals . ; : :
(c) Other {itemize) .

CH

. Subtract line 8 from tine 7. Enter difference (if

line 8 is greater-than tine 7, enter zero).

Total—(Add lines 1 and 9. Enter here and on
Form 540, page 2, line 55)... . >

Child Adoption Expense

11. fatal axpenses paid or incurred—Attach itemized
12. Enter 3% of adjusted gross income shown on Form
13. Subtract line 12 from tine 11—See instructions -
for maximum limitations. (enter h here and on Form
. $40, page 2, line 56) . rn
Taxes :
. 1 R Real estate
_ 15. State and local gasoline
~ "16. General sales
17. Auto license—Excess of registration a and weight fees
(see instructions) .
18. Personal property. .
19. State disability insurance (SOi—Employer private
. disability plans do not qualify ..
20. Other wo. rin a
21. Total taxes—{Add lines 14 through 20. Enter here

and on Form 540, page 2, line 57). . >

(Rev. 1974) wo
NW88326 Docld:32245535 Page 68

. 23. Installment purchases

28.

_ 35. Alimony pald

Interest Expense i

22. Home mortgage .

24. Other (itemize) .

25. TotaliAdd ‘lines 2, "23 and. 8. ‘Enter here ad :
on Form 540, page 2, line 58).

Contributions . oso

26. Cash contributions for which you have recelpts, can- m
celed checks, etc. .

27. Other cash contributions. List donees and amounts ,

Other than cash. —-See instructions for required :
. ‘statement : . .

29. TotaliAdd lines 26, 27 and 28. Maximum deduction ~
may not exceed 20% of adjusted gross income. —
Enter here and on Form 540, page 2, line 59) . >

Miscellaneous Deductions

Casualty or Theft Loss(es)—See instructions

NOTE: If you had more than one loss, omit lines. 30
through 34 and follow instructions for guidance. "

30. Loss before insurance reimbursement
31. Insurance reimbursement

32. Subtract line 31 from tine 30. Enter difference ‘it :
- fine 31 is greater than line 30, enter zero) :

33. Enter $100 or amount on tine 32, whichever is
~  smaiter : .

34. Casualty or theft loss (line 32 less line ‘wi

36. Child care—See instructions.

“37. Union dues - a
38. Employment education expense—See instructions ae]
39. Other—See instructions (itemize) . :

40. Total—Add fines 34, 35, 36, 37, 38 and 39. (Enter
here and on Form 540, page 2, ‘line 60) nl od

EMT SABRI ABP ETHERS ARTE PD MERI AA bP LRP HATRED S AT AUN EL ESET A SLR RS RRS TT NSA SES OTE IE RTE TRS URNS 7
eee res > Me Qe oy te * a ° ae

PROFIT (OR 108s) FROM BUSINESS OR PROFESSION

- . (Sole Proprietorships)

Attach this schedule to your Income tax return, Form 540.or S40NR —_— Partnerships, joint ventures, etc., must file on Form 365 -
Social Security Number

/ wv _ oe 22/279
A. Principal business activity... pa RB. Ve Cc. Ee. cote sacastnee sscuceneaeeseeateesesnnneeanece ; product... all CEBAR.

(See Instructioris for ‘Item A.'’) (For example; retail—hardware; pees sarvices—legal; manvufacturing—furniture; etc.)
.. B. Business name... e Woo oe y B (STR.O Cor FEES eee
D. Business address.. Mors V NTA RA BL OD ve cetaecleecesetoeeeseseeun
E. Indicate method of accounting: [(} cash; i accrual; i Fe J MP coda)
F. Were Forms 591, 592, 596 and 599, maw, calendar year filed a required)? oo ' EJ No io
G. Method of inventory valuation P.. ST eeeeeee SY:
Was there any substantial change in the manner of determining quantities, costs, 0 or valuations between the o opening g and closing inventories? ;
If “Yes,” attach explanation.

Name as shown on Form 540 or A40NR

{MPORTANT—A!! applicable lines and schedules must be filled in.

- 1 Gross receipts or sales $__ Less returns and allowances $..-
S| 2 Less: Cast of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) .
9 3 Gross profit ,
Z) 4 Other income (attach schedule)
5 “TOTAL income (add lines 3 and 4)
6 Depreciation (explain in Schedule C-3)
7 Taxes on business and business property (explain in ‘Schedule C. 2)
8 Rent on business property ry rn sone
9 Repairs (explain in Schedule C-2) . . . . a : i an vee :
10 Salaries and wages not included on line 24, Schedule C 1 {exclude any ‘paid 1 to yourself). :
WL Insurance |. a
12 Lega! and professional fees . . : 7 a
13 Commissions. . . eS OO
14 Amortization (attach statement) rn es [ee .
w|15 (a) Pension and profit-sharing plans (see Instructions for line 15(a)) . , , .
3 (b) Employee benefit programs (see Instructions for line 15(b)) oo 7 an oy 4
5 16 Interest on business indebtedness ©. 2. 2 6 2 2 we me Se
5|17 Bad debts arising from sales or services a
18 Depletion . . we ee ee Le

19 Other business expenses (specify):

(h) Total other business expenses s (add lines 1916) through 19%(g)) . ee ge
20 Total deductions (add lines 6 through 19) . Co ee ee ee ee ‘Cy rt

21 Net profit (or loss) (subtract line 20 from fine 5). Enter here. and on page 2, Form 540 or Form S540NR ©

- SCHEDULE c-1. COST OF GOODS SOLD (See Schedule C Instructions for line 2)

22 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) .
23 Purchases $000 Less cost of items withdrawn for personal use $....... vevseeee vente _ “Balance >
: 24. Cost of labor (do not include salary paid to yourself) vee ee fa rs - an eee
- 25. Materials and supplies a ee oe ; ° : a sessed _

26. Other costs (attach schedule) 2. 60 ke ee ee

_ 27 Total of lines 22 through 26 °. a . noe ne
28 Less: Inventory at end-of year. . . _ Re
29 Cost of goods sold. Enter here and on line 2, ‘above. Le - .

: NWW88978 Docld:32245535 Page 69


SALE Re CREPES AR SPCR AIS AEE DSRS STATA MR j

L

Schedule C’ (Form 540) (Rev. 1974) De SE. Page 2
aaa em nena
. SCHEDULE C-2. Explanation of Lines 7 and 9 ;

Line No, Explanation

Amount

Amount

’ SCHEDULE C-3. DEPRECIATION (See Schedule C Instructions for line 6). NOTE: Depreciation may be computed by
using the Asset Guideline Classes Specified in Federal Revenue Procedure 72-10, regardless of when assets were:
placed in service. If this method is used, do NOT use the Lower Limit or the Upper Limit (ADR) Ranges. Attach .
detailed statement of depreciation computation.

a, Group and guideline class b. Date c. Cost or d. Depreclation e. Method of f. Life or |g. Depreciation for
: fl 7 allowed or allowable computing
or description of property acquired other basis in prior years depraciation rate this year

1 Total additional first-year depreciation (do not include in items below)
2 Asset Guideline Class System (See Note above)
3 Other depreciation
Buildings .
Furniture and fixtures . .
Transportation equipment. . 2. fo. en nn Corn
Machinery and other equipment.» fo. a veeeelecscae|ooeee
_ Other (specify)

4 Totals
_ 3 Less: Amount of depreciation claimed “elsewhere in n Schedule C1
6 Balance—Enter here and on page 1, line 6 .

SCHEDULE C-4. Expense Account Information (See Schedule C Instructions for Schedule C-4)

Enter information with regard to yourself and your five
’ highest paid employees. In determining the five highest
paid employees, expense account allowances must be
added to their salaries and wages. However, the infor- : ;
mation need not be submitted for any employee for L[ AB crrttrrererceregrey sees rene nun ennnnennencernes
’ whom the combined amount is less than $10,000, or .
for yourself if your expense account allowance plus. _ it On BO nena en .
tine 21, page 1 is less than $10,000. ns es en ie i

Did you claim a deduction for expenses connected with:

(1) Entertainment ility (boat, resort, ranch, ete)? . ‘(3) Employees’ families at conventions or meetings? ne
C7 Yes No so 0 Yes © No ;
(2) Living eccommosictions (except employees on business)? (4) Employee or family vacations not reported on Form W: 22

No

Y ae
nweedsee bert rae: a5 535— O = ;

A RAP EAR BET ASRS Bat RTE E EEE SAR REPL ATT OE EFI EF AAP ie EE a vr TTR
a . yee st a i or a pe

CALIFORNIA
CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

TAXABLE

sat.

" FORM 540.
Use this schedule to report gains and losses on stocks, bonds and similar investments,
and gains (but not losses) on personal assets such as a home or jewelry.
Name as shown on Form 54 "¥ 4ONR /) — _ : ; joel f -
ta Eb. Me burs u_ fs _—_ 2.2/2. 779?
PART I—Assets Held One Year or Less ; . - :

e. Cost or other basis as
: adjusted, cost of subse- .
a. Kind of property and description b. Date acquired ¢. Date sold d. Gross sates quent improvements (if f. Gain or loss”
(Example, 100 shares of ‘‘2” Co.) . (mo.. day, yr.) (mo., day, yr.) price ‘not pprehased, attach Lo (d. fesse.)
. : explanation) and = ex- vate
: pense of sale ;

SE CAN Ta Su MMiTTE AELE

joo CHIEFTAIN DEXEL 3 |6/70/
“|e perme tse (e402

“2 E Enter gain or loss), ‘if “Gpplicabie, “from Tine 18, ‘Schedule D- 1 (540) {attach copy) .
3. Enter your share of net gain or loss from partnerships and fiduciaries .
4, Net gain or loss, combine lines 1, 2 and 3

PART I!l—Assets Held More Than One Year But Not More Than Five Years

7. Enter your share of net gain or loss from partnerships and fiduciaries :
8. Net gain or loss, combine lines 5, 6 and 7

10. Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach copy)
11. Enter your share of net gain or loss from partnerships and fiduciaries . .
12. Net gain or loss, combine lines 9, 10 and 13 .

PART 1V—Summary of Capital Gains and Losses
13. Enter amount from line 4 2 6 1 6 ee 4 2. Fp i
14. Enter 65% of the amount on line 8 ee ee eee. JQ pOY sud -

' 15. Enter 50% of the amount on line 12 . oP e ,
16, Enter unused capital loss carryover from preceding taxable years "(attach computation ek 509
17. Combine the amounts shown on lines 13, 14, 15 and 16 , .

. 18, If line 17 shows a gain, enter here and on page 2, Part Il of Form 540 or ‘540NR
19. If line 17 shows a loss, enter here and on page 2, Part wy of Form 540 or S540NR the smallest, oft
(a) amount on lines 17; . : .
. (b) the taxable income for the taxable year (computed without: regard to gains or losses from sale or exchange
of capital assets; or ; :
(c) $1,000 ($500 in the case of a husband or wife filing a separate return) |

NW 88326 Docld:32245535 Page 71 - .

y

wane _ Simuar L faye Lts Kuby CALENDAR VAR

_ ADDRESS 322-12-7? : SOC. SEC. NO, —____

ES ER PETE SEGRE TARA ERR PUSS Bee EEO EU ee OY A PSS Re EE RON

DEDUCTION SCHEDULE o

“WEDICAL___ [STATE FEDERAL CONTRIBUTIONS STATE FEDERAL
2 MEDICINE/ORUGS | {| f2teartNersniesnane ew |

3 LESS 1% A.G.L. (Line 18 - 1040) GIRL/BOY SCOUTS
HEART FUND/CANCER FUNJ

4 NET MED/DRUGS
5H & A INS, (4 + EXCESS)

P|
P|
fia DR. ‘ \f Jt at [oT
OR i po
DR. Ko |_| Pourrica contrisutions/” | pe
OR. cHuRcHeS | ff _ aE
— eee —
DR.
J pe
|. sds carry over FROM PRIOR YRS Ts
6b HOSPITAL pat | 24 TOTAL CONTRIBUTIONS 3 A T ISO |
PROSTHETIC. APPLIANCES CASUALTY OR THEFT LOSS(ES): j
26 INSURANCE REIMBURSEMENT [ff
6c AMBULANCE — 27 Difference (not less than zero) [ {||
LABORATORIES Po fa stoo citation Per cas.) | i
TRAveLFoRMeD. (yD | —s| | DO |. 29 ror.casontHerttoss PY | |__|
: — MISCELLANEOUS DEDUCTIONS
MEDICARE INS. 30 ALIMONY a
GLASSES | | |31unionproressionacoues [| | of
7 MEDICAL EXPENSES . pa =| 32 CHILD & DEP, CARE (Form 2441)
LESS REIMBURSED BY INS. ; 33 INCOME TAX PREPARATION Pf
8 LESS 3% ADJ. GROSS INC. | =f UNIFORMS/PROTEC. CLOTHING a
9 FL ae GIT smatc toousanosuppuies [OT
1__+:% (TO $150) OF H & A INS. Po SOT TT caunory ano CLEANING __- a eee
10 TOTAL MEDICAL DED. 1386 1 PT web tT Auto Use Mi ————E
TAXES LINVEST,COUNSEL&PUBS.Schedf |
11 STATE & LOCAL INCOME Fr | | emecovmentacencyfeces | - - .[ JY. |
12 REAL ESTATE a 2-7 | | sareverosirsox TT
13 STATE & LOCAL GASOLINE el | re.reaineusiness [| of
14 GENERAL SALES TAX + | ff —_________}- ____|___J
184 PERSONAL PROPERTY os re ee ee
15b PERSONAL PROPERTY AUTO ee See
IG STATE DIS.INS.H WW ——————————
SALES TAX AUTO — 34 TOTAL MISC. DED. a
: ee
| || —— | any oF re OE a FEDERAL
rota Taxes S779 0) SS
INTEREST (TO WHOM PAID) BETOTAL TAXES (FromLiNEi7) J. | Of
18 MORTGAGE il #3 | | 37 TOTAL INTEREST (Line 20) a ee
a [—aerorac conta. tinwan |__| J
fr TB cas. & THEFT LOSS(ES) (Linea) FT
“IQINSTALLMENT LOANS ee es Crack e pT
MERR — = : a ee
TRAC 6, | ee ee eee
BEL C | PAT RIES on PokMe tao Line as STA NS sFO |
po Fras
ee ee eee
20 TOTAL INTEREST 3992+ 192992 | z= ae

| NWAGSES6 oDecle2245505, Rage?anaeles, Calif. Form 101 . _ . . fot

SPEARS OT ARG AB BERG TY

SE AALS IERIE RARE Cae EPS A ORR oe PSSST NEN TPE SR

wwe Sauer L bay

_ ADDRESS 322 -~/i-? ? : __ $06. SEC. NO.

~ MEDICAL
2 MEDICINE/ORUGS

STATE

wows kuby

; FEDERAL

DEDUCTION SCHEDULE

CONTRIBUTIONS ;

21 PARTNERSHIP SHARE

STATE FEDERAL

J LESS 1% A.G.I. (Line 18 - 1040)
4NET MED/DRUGS

5H & AINS. (% + EXCESS)

6a DR.

1

“DR.
DR.
DR.
OR.
DR.
DR.
DR.

6b HOSPITAL

GIRL/BOY SCOUTS

HEART FUND/CANCER FUNY
RED CROSS/UNITED FUND
XMAS & EASTER SEALS
MISC. ORGANIZED CHARITIE

FO Y |

s

POLITICAL CONTRIBUTIONS/ |
CHURCHES ;

22 OTHER THAN CASH

23 CARRY OVER FROM PRIOR YRS

24 TOTAL CONTRIBUTIONS

PROSTHETIC APPLIANCES

CASUALTY OR THEFT LOSS(ES)

HEARING AID

6c AMBULANCE *

LABORATORIES

25 |.OSS BEFORE ADJUSTMENT
26 INSUMANCE REIMBURSEMENT
27 Difference (not less than zero}

eT
UB

_TRAVEL FORMED. | () U™D

MEDICARE INS..
GLASSES
7 MEDICAL EXPENSES
LESS REIMBURSED BY INS.

8 LESS 3% ADJ. GROSS INC.
9
1 +:% (TO $150) OF H & A INS.
10 TOTAL MEDICAL DED.
TAXES
11STATE & LOCAL INCOME

:

12 REAL ESTATE
13 STATE & LOCAL GASOLINE

14 GENERAL SALES TAX

15a PERSONAL PROPERTY
15b PERSONAL PROPERTY AUTO

16 STATE DIS. INS. H w
SALES TAX AUTO

17 TOTAL TAXES

INTEREST (TO WHOM PAID)
18 MORTGAGE

= SUMMARY OF ITEMIZED DED.| State
AYO TORE TL [3 ee ess Fron tine io 6 ONT*

xe)
N

i

—s 28 ($100 LIMITATION PER CAS.)
(-)

| [29 ror.cas oR THEFTLOSS >

=
2c)
i)
m
lal
-
>
2
m
i=]
—
77)
o
m
i=}
c
°
a
i=)
2
|

| [30auimony

| [31 union/PRoressionat DUES _|

PIS OY | [32 cHiLo & DEP. CARE (Form 2441)

YS 83 INCOME TAX PREPARATION

| 2698 | UNIFORMS/PROTEC. CLOTHING
2S

igs, LAUNDRY AND CLEANING
£ Auto Use Mi

idl

:

EMPLOYMENT AGENCY FEES
SAFE DEPOSIT BOX
TEL. REQ. IN BUSINESS

34 TOTAL MISC. DED

=
:

INVEST. COUNSEL & PUBS.(Sched

3G TOTAL TAXES (From LINE 17)

37 TOTAL INTEREST (Line 20)

19 INSTALLMENT LOANS

38 TOTAL CONTR. (Line 24)
139 CAS. & THEFT LOSS(ES) (Line29)

MERRILL AW
[RAL AID

LE fal h

il
m
o
mi
a
>
rc

BLT...
CBD a

20 TOTAL INTEREST

w

NVRBSE2G CDOT RAIS STIS. Pago ya nceles. Calif. Form 101

\)
5

I

. 40 TOTAL MISCELLANEOUS
DEDUCTIONS [FROM LINE 34)
26 . :
[7 TOTAL LTEMIZED DEDUCTIONS : ™ ro
41 INTER ON FORM 1040 LINE 45 my £4 ¥ ow £Y

REMARKS

(2.9

:
a


ea TE a BRN PED TT TRE ID ee JME ITS ST SR DEE RASS MS BRE I PEND EN NLT TER BOP ERIS CH OE RARE TRE ELT OIA

4

Moe LLIs RB - : a

“ADDRESS __ 222 -/ —?97 SOC. SEC. xo.

SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION

PRINCIPAL BUSINESS ACTIVITY :
BUSINESS NAME . mo : EMPLOYERS NO.

BUSINESS ADDRESS

TOTAL RECEIPTS fi
INVENTORY AT BEGINNING OF YEAR .

MERCHANDISE PURCHASED

LABOR

TOTAL
INVENTORY AT END OF YEAR

GROSS PROFIT

GROSS [NCOME

OTHER’ BUSINESS DEDUCTIONS

a

Xe!

ADVERTISING

4

S|

Uy

2

[Ps

AUTO AND TRUCK EXPENSE laAre-?P
BAD DEBTS

CASH SHORT
COMMISSIONS

DELIVERY

aE
x
»

DEPRECIATION ( SCHEDULE ATTACHED } _ '
DUES AND SUBSCRIPTIONS .

ENTERTAINMENT AND PROMOTIONAL

INSURANCE ©

:
:

INTEREST

JANETOR SERVICE
LAUNDRY

J
Lon
|

LEGAL AND ACCOUNTING

:

MAINTENANCE
OFFICE SUPPLIES ANO EXPENSE

RENT

REPAIRS

SALARIES AND WAGES
SALARIES OFFICERS

SUPPLIES ©
TAXES AND LICENSES ‘ a , ,
TAXES + PAYROLL ~ : = . | Ses |
TELEPHONE ‘ - ;
TRAVEL
UTILITIES °

_ FARK? NG

&

~ »>
. hol
.

“CNET PROFIT OR LOSS ) - FEDERAL RETURN

i RRA A

Et

NET PROFIT OR LOSS ) ~ STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF. 1 aj)’

PROFESSIONAL STATIONERS INC, FORM 104

mS : SCHEDULE |
NW 88396 “ASG sddnb595 Page 74 a ne SCHED

TERE HE eT Sr ra tig, rcaess BANOS SBR SLE CES PRE SEARS ENROL UATE SEEN APR BEAST :
e a Fa
re o ve ~ £ Bry
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2a 2 gee
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DEPRECIABLE

SPEC 20%
DEP

SCHEDULE OF DEPRECIATION / AMORTIZATION: -

a n ||
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° = S
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KIND OF PROPERTY

ADDRESS
TOTALS

NW 68326 Docld:32245535 Page 75

“SCHEDULE. ————___———.

. CALIF. FORM NO TO2ZA

LOS ANGELES

“ING.

PROFESSIONAL STATIONERS


4

(Ss Ley ohinaunt-of thie Treooury / Iegornal Rovonue Sorvica eo” crt 9 ONG
LSS (nclhviciced Income Fax Rotarn => * FO) IQTL

Q
74, or othor CnObla yoor BOGIAIAG 1. eee

4

eae

Lost nome Gaur celal rca 7
Reihcad’o, Moi Ce ae
RUBY cas any
ei a
3 Gumbce, €7 merch seuto) . | Citoto curctca, 8 fein’ acm, :

89S [349 436 13420

eee: meen enepenenee nes sok Ep eyee ~
, BOM Lay Sokicus a es Tints HOSUowlvO™ 7

: Exemptions | Rogular / 6S orever / Olind Enter

: | Gyoursof. . . . . & , O f° Gano
iaing ko r kun (oven if erty eno hed ineoma) =| 7 Wifo (husband)... oO
are ociy. 1 vic (iuchsnd) ts atco | O First names of your dopondont chitdron who Htved with

: 3 isk eounty humiber ond fos you _Frad, Brinn, Elion, Thoman. =

. “. “
| : . : ; . oy cote me ee rename oe ans crrmenre eer camer rine f Ns

a first nemco Cad gilddla Initista ef bate)
YANG

i, ineludiag cr :

!
{
4

he meh anily one:

. bee ' . ee naa pales ane tite Hier oe ebm aint” aie “4
Ye bat a a . wee ae bilcate| f°.
2 cr hac’: magne child (kat wysuvet cath | 9 Number of other dopandents (from line 32) 6. Et
: oad CW > 8 ys . 10 Yotai oxemptions claimed . . . . . + . Fl &

21 08, C5el03, tiga, rid choy ciiployca eomponcation. yy ynovariclio, uttcen ononation) *

an a camin

ae ene

(Attach Ferm Vie? to front.

wee tee |e nme tee eee | ere

)

a | tuba’ OSs Ook) g F000 321 Logs oxelusion § 70.00 atone . [>
— cf vet, ¢hddonds and ethe7 elatrigutions Cro over $200, Nat in Part | of Sehcdute B.)
qo | 7 : I? CZI9 or.t2vs, entcr otal without listing in Schcdulo B
|
|

dh

aff eves. CE°9, onter toccl and list ja Port I of Schcdulo BJ * °
DA WEECS, Guicouds, and interest (from ling 45)... ew kes
BRD, We, Wace WY ee ee ee ee
18 ineorna (Cc 73 “ciek oy,” moving orponses, ete. from tino 50). Jee nix meer eee few
20 rom Nia. flacomo) . ) ee ee ee | _ andy &
& you do not Romize deductions § © 1 yeu itemizo dodust
ond Ino 27 Is under $20,000, liao 37 Is $10,039 ev 6.
ies { # ia YiuSleo ond ontor on $0 Hird BE Fo HOUFO (Ot, h
ue HO). So, - :
okie, | [uf You Roto Scheculo % Vor 2
x} | J Schedule | or Form 4726_ _
{vor ling GL)‘.

vavact no 29 {vom lino 18)...
ty (rom lina GF) wee ae be ee
1 38°20 and 28) rr
wa’ § Income tox withheld (attesh Ferms W-2
BPW HOM .

Ui, ow tan poymonts {include emount allowed
ACTA roturm) . 4. Se ,
“ity Foon 4868, frplleation for Lutomatic Extension
"1 44.8, Mndividual tnyonta Tax Return «

yeatty Grom ling 7B).

nde Mase 23, 24, 25, and 26). .

. pe ‘ Pey ta full with rotum. Cloto
“jan line 27, onter BALANCE DUE IRS eticat or monsy ordcr payuslo b P28}

Ling 22 Cla

tcmnal Rowwaua Ecruizo

wilhso 67 E

Shan lind 22, onter omount OVERPAID. . . . . .'. 2D |

— te te Leo |
imatcauies [8 | | | GUMMY

4 ¢anable yoas, have any intorest in or signotura or othor autherity Leas
‘" re financial account in a forcign country (Oxcept ia a U.S. _ :
by a U.S. Anancial institution? . 2 2... wwe & oo Ey.

|. (ior definitions, see Form 4683.) . as
a i nplete Rovenue Sharing (lines 33 and 34) on next page. = ae
_ “Wiel. ponds fb dcsbura thet | kovg caamained to rotuca, including ceeampenying schodulon ond ctatomonto, and ta th baat of ray knezicigo ond balict
a : it ts tres, geriec?, cht femiptety, Doclaration ¢f aruparer (effin tisn taxpayers is booed ca ofl information of which he hos ony inewiedgo.
3) Sere, vs ! ED D ARAREF ie 1
, Py en le il fe guetta tes Le Lge eee vate p> aN | : 22 | ee :
w Lore Vour Aw tue . Dato Properor'o 6 an Pe le bla . Dovo a
@ a a oe 17835 VENTURA BLVD., SUITE_106. ; .
te “ Wifa's (hugbund’s) signature (if filing jointly, BOTH must sign ovon if only one hod income) | Address (ind CW der AL Tpsesg q's lige. Idcat. G7 Lea, { :
a _ we . . TEL. (213) 881-7350 dy

: , . oe toe S.5. 568-40-9527
| NW'88326 Docld!32245535. Page-76-.


+

x
Pogo 2
selonchip YOu Amount fumiohad
® Rolatlanohip fe) Benana lod In Mod @ ert haw 1 Ae or do- i) SINERS includ:
duging yoor, writo 8 or incoma ondont’a support. ing dopendant
oD. $750 or morcl # 100% writo ALL.
5. ——— g
¢3 Mets ba column, (0). Enter hora ond on tino 9 . : |
‘ your pices ef revise:29 at cad of yoar (not nocosscrliy 7) cama a pour post wiles Paice). 2S
becky, Wt yes Need ingido tho boundorica et on Incorga- (a) Towsosbla Ae icrction ¢ ¢ ,
ed a tia, c2., catcr its noma; Hf ast, ehosh fore [> 18) a.
hog HET?! may "
z oT
rent 730n0 ineieccd on Hag “ ys GEA TAL TEE Lilegrm We me
| 0 rauen of tkolr own; ov, (2) | g y 13 ite . j 4 y
aod wipal plc|eg of residence % J : \ H H Z..
; aD GMO, Libel Mlle ET, Mle Ze
ws say CHI titorost .
: “y Csole sp tetra Gene an Cee ee ee Lee
: SR Eta he ea. ob cy onehoncd ef capital cesta (attach Sehcdulo D) . toe
: SY Ng 8 eg) trom Sepalomontal Coke dul of Golno ond Loscos (attach Form 4797)...
: Ps oto canuiticg, ronks and royatiics, partnorchias, cotetes or trusts, otc. (attach Schcdula E}
No8Q (ee toca) fattosh Schadulo Ff). . 1 es - . o
i C4 rely f2 mabto (odions ond annulilos (net roportcd on eshodulo E200 Instructions on page 8) .
pO 495% of eat gala eoselputlens (nee rcgertcd ea Cchcdulo DY). 6 ee ee
em ota income Cort pafesne. 3 (coutten-—oc9 inotresctt ‘one CA AGI B) . woe ees
49 PMraeay > ee able bbe ee te ee
? £9 \Cuaar nth pure awd GOURD) vo we ee
_. 66 Titel (end Bios 85 Sarcugh 44 herg_ond on Mra M4. ee
: yu. “
ae  tneeang (ottngh Vorm 2040 oF ethor roquircd ctatemonty. » . . «| ES |
uv eNOS) lee tee ee La —.
( «2% Ausit Pet 8803 €7 €OX ce oeazcmont) 1 + + 6 ee es i i "oul ieee
: ( a jroo C9 11 2odlroiion | 19a, Ces, (voo Forma 4840). . 6. £2 wales *
Hy a GAS OA LVS ner, 9 oad.en! Nao 3G . . le —
bd bbe a {rol reiue
ve, Eyucese “aia Tifa M7). .
6 (ey aes ‘amor totnl trom Scincsluta A, ‘tina 40 and attach Schodulo A|
os @) Kt Jc cuctions, gator 15% o7 lina 51, but do NOT enter more .
: 6s) Set ea Nora tie BE rr ran Loe
‘ . CO pguitioty teeck aumbds cl oxomptions cloinied on lina 40, by $750 .
{> Veneto ke oe Subtest ting $4 from tina 53.0. 2 ee ee ee .
 (Vigurc: itn GIO AMOUR On line 5S by using Tox Rate Schedulo X, Y or Z, or if applicable, the alternative tax from Sched-
n2 DB, 2 earache srom § Schedulu G, of maximum tax from Form 4726.) Enter tox on line 18.
ve 1 a see ea, ST SS SS EN IEEE a — ae
be ww le : ead ee :
othe nae eth “eh Sehuduto ) _ ES oO
Wena DAC8) ee en re toe ee a 1 OF a
; x omen
‘natn 146) « a 2S en ee
ati:tidatoa (ev public efflec—ooa inoiructions on pogo® . . - . 60 | et
_ nt {nttoch Fora £074) soo C3 :
lines 63, 7,58, 59, ond €0). Enter horo and on lino 19
/ \
C2 Solt-er.aleyincnt tan (civ ch Schedulo OF)... .

C3 ‘lan fron: coconputiag pvler-yoar investmont credit (cttach Form 4255) .

CS Cliniraus: Cox (era inctarettgno on paga 86). Chock hero O), If Form 4625 is attached . . . . 63
e P83 Cselel 9 7 tax ea Sip tweome not Fayortad to omployor (attach Form 4137) . 6B |
‘ ret i sanity ton ea ‘ips (ror Forms w-2) . . 66) at 2
ce | G67 52470

C3 Excoo ne We oy, vega A (f 46° ‘67 More ChiBloyoro—ccd Inatructions on page 10) . .
CD Brodit (ar ¢ceforul ton 64 ) Gpoel, | fuals, nonhiihway gacatine and lubricating oil (attach Form 4136)
79 Grodie vera O Kogulutcd Invougmont Corapuny (attach Port 2439)... 6 6. ees
"2 PA Fetal (udd tive G8, G9, arid 79), Entor hor ond on Wag 26
; - . : , tous CoaVE RAMIENT PIPING Wn Wi 0 4 068 A GPO T44 601 ras

NW 88326 Docid:32245535-Page77-.

nie ne eR PR Oe enema


7 | ;

Q,

Chace talos Aol s—tomlzod Waductlons AND ay.
Gera WO) is.” Divtele J ed VD
Cerca Me) ke Yiviconel and Iuverest Income ©

Invernal-Roven Ravens Sorvica m, a Attach to Form 3 2049.

Name(o) as shawn en Form 1040 1 v Vour ceelal ccounty CyeCc7,
rn ac “Man Baby oe 22:32 1 :

wg f: . Somat eG 2) :

oan aan Se ee OD ene ee ere enn amen +
oo cy “Tnotraneo Contributions. —Cash—including ehceks, monoy ardc7s, Cte, «!
3, Gacioi, ddntists, nurdes, | (Itomize—see instructions on page 11 for exampioa.)
} “top medle: PENPO, CVE. ie .

ae ‘aival ree

i no he 9) CF ae POS
ay OW a ‘On (LO,
° ; saptans Gee meee oe
So tA hy Wed Us 40 Total cash contributions woe |
, . ; eee Ge 19 Othor than cash (860 instructions on »
rere for @lvor |, a page 12 for required statement). Entor ;
x OO shat OVO) oo |e | total for such iterns haro. . nena
“.‘Gntgr bolan, Pras jeuraite prerilums for’ 20 Carryover from prior yOars «© 6 + | menenn—necmemnne
‘ .. gardleei ear .ae: ontoercd en ling 1... |---| 21 Total contributions (Add lines 18, 19, and
: G Momize echorhacdiet ond dantal ox. : 20. Enter hera and on line 35, bolow.) [> 200.
ey * ponecs. So Aourlac, aids, denturas, - ae a :
—ayogli: 3c, SSbLosors glut, ote, y: Intoroot oxpense.
‘ £ : peg tee Sameera, Lennon mee —nettanenenen | 8% Homo mortgogo . s+ + + + +
. 2} Inotollmont purchacod. . et | oe ees
_ 2A Othor (itemize) ee eee
1 23 Terol intorest oxpoaco (Add linca 22,
: 23 and 24. Entor hero and on hina 36,
: bolow.) woe oe.
: Casualty or thon Isao {ca) :
Soe instructions on page 12. NOTE: ‘if
you had more than one casualty or
thoft loss occurrence, OMIT lines 26
through 29 and sce page 12 of the
e) instructions for guidanco. :
: 23 Loos before odjustments. . . +» +
a . 27 Inouronce rolimburcomont . ..
7 , AA, Boia 1040, oe eee sit | 28 $100 imitation. 2 6. 6 ee
® os Sabatrn ss « tij.. fern Hie ys Envor distor | . 29 Add lines 27 and 28 .
: Jo aes o 2070; Bier he a 30 Casualty or thaft loss. (Excess ‘of lina
a” al ns GONE arse’ | =| el 26 ovor line 29. Enter here and oa line ;
ad 5 Toe Enter fiora |. ef 37, below.) ale
nMOS se be 15
‘ pia acannon ie 3) 00, 31 Child and dopondont care oxponces
eo, oo, ; ; from Form 2441, (Entor hero and on
01) gue a ee P . _. _ling 38, below.) . . b> :
ie stniaine fowl casollnc (ava gay ton tables) J _ “Miseollancous doduetlona for ain,
. ne : t st n
i @Coneres sok 3 (Gud sale, fax tablos) . : es ee Mo ge 13). etc. (seg Instructions on
3G State ti loest incomd , : rs ‘ de. | __
ny Parson ORY te Se ns _|___| -
Te 6 Oger, . Lee neces a as ee a an ee eee poe een eee we Pee _—_-
i AD Total fae 0 (ad ines AE thyough 16.. 861 HEL 32 Yetal miscellancguo Coductiono (Entor oe
Rater novo esr? on lag 24 below.) a oe hore and on line 39, Below.) - aot _
4

s : "otal tomy tr i VW) don. a a
oy otal eosutons (fe ine 23) a ,

, 2 suc, 86 Total Intorose axpense | (irum lino 1) ee ee ee
: eo 37 Casualty, and theft losis) (from line BO). fe a,
s 23 Child and dopendent cure expenses (from line 31). 6. 2 6 se ee Ce ee ee ee Fe L

m 39 Total miscellaneous deductions (from line 32). Coe ee
~ 40 TOTAL ITEMIZED DEDUCTIONS. (Add lines 33 through 39. Enter here and on Form: 1040, ‘line 52 fh/A b> 4 abe

_ NW 88326: Docld:32249535;Pagé-78 : .. eet

“Pie Kg _. IDENTIFICA. no SY TLE TD

. 7 ear)
MALE _ a pe dthe

ABDRELS

v

CMEDULE OF DEDUCTIONS _ YEAR_ENDEO.
“STATE || CONYRIBUTIONS FEOEMAL & STATE

CHURCHES | 160 |
ee eee 7
_Gorimuntry cHest/uniren crusace | |

SALVATION ARMY/GOOOWILL INDUSTRIES fT

RED CROSS aoe
KMAS & I EASTER sé ALS
HEART | FUND/CANCER FUND”

PARTNERSHIP RETURN
__paynounpeouction
City OF HOPI 81 —

[ [|__ ower oncanizco CHARITIES: | /00 fy |

l| “YOTAL CONTRIBUTIONS | ang (0.

Poe INTEREST (To wyoy Pain) | FEBERAL & STAVE
MORTGAGE LOAN Q) OAL _ mney wea

INSTALLMEN NT LOAN

lay Aiea fis |
. ile INE. FM
Ire See

________TOTAL INTEREST |_
| _- || CUISEELLANEOUS ODEOUCTIONS

[|] atiaony exPLainy |_|
| _||__ sare cerosiy Box Fee a
[|| union pues PT

SMALL TOOLS (GOOD 1 YEAR)
TOOLS DEPRECIATION |
SAFETY EQUIPMENT _ |
UNIFORMS {NOT GEN. _ WEAR) ee.
LAUNOAY a ol EATING _ J | ]
_ AUTO . MIL EAGE. o. _
| FHLePMONG expense ‘mor AciMa) | Ll.
@ oly {0 be __EMPLOYRIENT AGINGY PEO
Bogus, 1 grail | ougs 6 guoserierions
7 INCOME YAN PREPARATION
Tomocare
OTHERS:

YOVAL RISE. DEDUCTIONS |

I[GASUALTY LOSSES texptainy

LICE ef
tt. Hey Geth ui

ame ca et ne

uf iin cy :

FEDERAL & STATE

tARgW CC

"sua | TOTAL,
iFss $100 06 ron FACH CASUALTY |

TOTAL CAL UALTY LOSSES |

~—FeERAL | gYATE_|
‘y Gy |

ee IN te nbn gat eee

ae Gur7 Ov, Siva | YOTAL DEDUGTIONS “Wf
IB WWAR ‘ Bel 17835 VENTURA BOULLVARL, SUITE 166
nw.ndiie CARR Adobe gp Nee ; ENCINO, CALIFORNIA 91316

foc omee

AN ORD!


Seth Eater ee

tay dei

NW 88226--Diseld:39245535'-Page"bo.~

De Mew ile
nde Wea a ait Crmigdeyor'u- Quagcrl ‘cry Fodoral tax Roturn, Form 244, tiiod for thio husincos for ony quartor In 1972? [7] YES {9} NO. ;
STAN Al exalleablo ‘hada and Schedules must be fillod tn.

SV

Tr ae

a am

enue Profit (or Loss) From Business or Profession
orn 0) (Sole Proprietorship) 1/2

Dopartinont of tho Troasury > Attach to Form 1640.
intornat Rovanue Sonics > Partnerships, Joint ventures, ote., must file Ferm 1065.
) ec TG ae | Secial sccurity numiscr

£121 7997 "~

Feao(s) e9 as shesat on Fora 3 neo

; product -.

C Employor tdantiflcation Number... cceeerecrcsceceeernenacaencanens wentenreccees

yo" BIva » mrt

ey tn ua aN) avin ond ctr a) ee “contgawng a”
hy, Le con wd ane ¢ eada eden eneetdncntevanscettens csctognaetae o ets veceeee detcececensetesspenaauneeteewennceseresaee

a tndlecter i aed Ww coset lag: qa) a ‘cooky “Q) Cy “pecrual; @) Oo “other.
roquieod fo alo form. A096 for 1972 (See Schedula C Instructions) [] YES _ CENT It “Yes,”’ where filed? [> ....

1G soecia'ln 107% did yay own thio buotnose? . DA...

a ‘3 Grego" 0" roca or aolca 6. saeteeesssesesecesestsence LODD POUND ONG allowancOD $F... cece Balance en een rrr ees eee

12 Es 28: 268 of goede oold and/or oporiona (Schedule C-1, fine 8). 2. 2. ee ee

7 (or wena (arr tho) '
‘ 130, Invannn tos 34 Iinag 8 ond 4)

Wyeth J
JOT 0 ee aga pre, Jong eae
Rowit. (oiotan in tla ‘e-3) oe i _
40 Eelarica cel 1 yogeg fey i lieluded on ing a, Schedula C-3 (oxclude any paid to yourself) . . . . |
8 2 mae ae ee : Fr

a) (c), ‘Ponciea: and prot sharing plans “hoa Schadula ¢ inotructions) rrr

, &) “Eigatex benatiz Rrograms (sea Geledule C Instructions) . - . . ee
a6 Wier ‘on iano Indgbtodnosa . we
V7 Gigde’ a ert ing trea gales ¢ or corvicop » poten ee
B ik wletien’ ;
Corr bere op

hoe ee

he ry

percep n
tS we

wdpestecsansencneeeeedensensenrsec-ceenemeeners .

nh ewnagee, AUN nen pean ne eens mao ere emee nae nensmewenaee | ce iswnnsemeawnsecemmmens | weenie

won mg nonenenesusaeenencuaneowan

een naemmagunnnneenenerwnm AE ADE Ren eden nee enememene re ter rT y Serna
1

bate sencqabboasnenouse eee. rT ee ee ee eee ee
(py "Total oghar businioss oxponses (add fines 19a) through 19(0)) 2 6 ee eee
20 _Tatal deductions (add linos 6 through 19)... ee ew
en =P

; aa Net profit (or loss) (subtract line 20 from line 5). Enter hare and on line 35, Form 1040, ALSO enter on
Schedulo SE, line 1. we . Coe eS 6.969 140
aa nea rel aE

ee ee fe eee ape

; Covina

Ce, pat

‘“Lenpehold Imps:

Sonwol dud Phyllsa Ruby

(1972:

- he,o9 Halos 3 Bont"

Bo

» Go0%
rede

@etne)

VR otarage
ovophouu
OAL AB

ea AG Woy

. Boudpuc
Porno fide
Honilevy.
Auta “ : 7
: Lagat
~Bonat ono’
FNewupoyore

ca aot con

(Balance of Lease)

NW, 88328 Docld:32245535,Page 84. ee

Sepebaw 3. va ff
WO 70 Nee Bath

tt oF
MLOo! Hizeol opi

bey
pane

NET icucoMe
Loags Deprecdagion

‘Ner TNCOMP.

$10,000.00

': 5,000.00

3,000.00

SUPPLEMENT_TO_SCHEDULE_C

DEPRECIATION

$4 ,000,,00
2,000.00

957,00

5 Yr, SL

2 Yr. SL

7 Yr. SL

$45,499.72

383.47

$ 800,00

4,491.98
16,463.08
2,923.29
3,102.44
$37,780.79

800.00

$45,116.25

26,980.79

$ 1,728.82
100,00
3,877.93
323.62
190,00
12745
25,00
254,15
382,25
214,51
12,15
425,29
=Qo
61.94

14,65

- 1,000.00

1B

$18,135.46 | ~

7737 056
$10,397.90
' -3,428,50
5 6969.40

2

$2,000.00: *

ri
4

428,50

$3,428.50

y

NKDULE SE! Computation of Soctal Security Self-Employment Tax 1972

Oral
ier hoe oe [> Each sel7-omnloycd persen muct fila a Schedule SE.
fntorl Rovenuo Servicy [> Aitach te Form 4C40. -

b Hf you had wei, including tips, of $9, 000 or moro D thee wora subjoct to social security taxes, do not fill in this pago.
bl 0? you ha Red k PHOTO | shan 6s 6n0 Qualngss, comiblag profita and loscos from all your businesses and farms on this Schedule SE. _

wv will be crodited | to your social sceurity record and used in figuring f social securliy honefits. -

ves u] 1 SSA L Ceeunry EARS) Csefal cocurity nurnbor
af celf-employcd parcen

| 322] 12} 7997

F- omploymoat gan (grecory | Store, rostaurant, , farm, atc.) [>

| JOR: wwiction of Not Ez wnings from BUSINESS Self-Employment (other than farming) .

: oo LA, 1 Net pr aii for cas) shown in S¢ehedulo c (Form 1040), line 21. (Entor combinsd amount H more then one 6.969140
' . : beaiesea) er er tee we ee Ce ne fA OF BY
7 ; Pot Inieont " Ge foao) ‘i oneludod coniéos or cauréion Included on tino bs. ee ee beeen |
© Ppowlyy ote g OCTUC LLP DOMED _ahogesseersscseseneneensnnnten raereees pecececses seveueseventcnseeveeneeraneoae .
1 Be Hot canilti 30 ted looay fog buolness colt. rcraployemont (Subtract lino 2 from tine 1, and onter hore and 6..969/ 40

on, “at ick Forts 13 tein & Alin Soll. Employmont

, A givmer fi may: “alcae to ‘ecorisute hot farm Carnings yaing tha OPTIONAL METHOD (lino 6, below) INSTEAD OF THE F HEOULAR
SEvtiOD fhiaa G, chow) 7 Ria grocs profits ara: (1) $2,409 or loss, or (2) more than $2, 400 and net profits are less than $1,G00.
LO your pres provcs {rom forming are not mero ee $2,460 and you glact to use the optional method, you need not complate lines

ond 5.4 eee __.
Sr aaton ae pe
7 * Commutation undor Rogular Motes
ra) Roo teen ‘promt (or !o38) from:
2 be Scheie F Bi lina 54 (cooh method), o7 line 74 (accrual method)

pote,

“satan uncar Opt

tonal “haces aed

wes 0 ue sh not farm roti io loca thon $3,609, ontor $1,600

powka Wei “nrinling aro $ha totol 0? tho greso profita from Schodulo F, lino 28 (each
of Had 22 (cseruul motied), plua tho dlsCributlvo ohare of gress profit trom varm
43 c3 onplalncd | in Instru6stovs for Schcdulo SZ.

oe 7. Ent a’ hore one: ‘on haa 800), below, tho amount on line 5 (or line 6, if you use the optional
* ve“ wothed) . . oe
a “ | pf sie sputetion! ‘ors Social Sceurity Sail. Enploymont Tan
a -_ 8 Wet ea imine ‘(or loss) from selt- -employment—
Po ‘@ From business (othoy than farming) § from line 3, above
3 (0) From ‘farming (from iino 7, above) *. woes Co

-e From ‘Lay iniorships,, joint vanturas, ote, (other than forming) . . .
td) Prom, Bois 0 a8 a nilnioter,” membor of a religious ordor, or a Christian Science practitioner. If you

beg Oo Aled b Pye 4361, cline hava [ | and ontor zero onthistine . . Lok eee ee

a oo _ G0) Res onske with 4) vercign Bovorniign’ or ingornational organization Ck ek
1G) Obi. CAlrcstor's tooc,/ote.). Spoclly clea bec ceevy weaeaeave ces ceutesaee

BO 29 Votal wot Curtlitga (or feno) trem solf araployinont raported on lina 8. . ‘

(U9 Heco © fy Koco Shon C409, you ore not cubjoe to colv-om@loymant ton. Bo not ail In root ‘of pogo. y
"10 The laryaot amount of combined waroo and salf-employmont oarnings Gubject
‘to social. sucurity tax for 1972 is . ; . foe.
43 (a) Total “PICA wages a5 ‘indicated on Form w-2,
(b) Unrcaored tips, if any, Subject to FICA tax from
"Forma 4137, lino 9-. . re ee tt _

89,000 | 00

(c) Total of lines 10) and 1b) se ;
42 Balanco (subtract tino 14(c¢) from line 10) . a
ly” AB’ Self. -emplnymont incomo—ing 9 or 12, whichever is smalier .
a: an 14 If line 23 16 $8,000, ontor 2675.00: if leso, multiply the amount on line 13 by 075. . :
‘a. 4, AB Railroad € fuiploye Q's and rallragd employoo represontative’s adjw.tment for hospital insurance henofits
: fox from Funia 4409. Lone
A 3G Golf. Solf-empluytnunt faa (oubtract line 15 iron lina 14), Entor horas and on h Form 1040, lino 62 . os yes So

[NW-88326 Docld:37245535, Page


‘ SCHEDULE D
(Forna 1040)

Departinent of the Treasury
internal Revenua Service

Name(s) aa shown on Form 1040

on on shyt Ruby

Capital Gains and Losses —

[> Attach te Ferm 1049. [> Examplics of property to be reported on this Schedule are 19) 7/2
gains and losses on stocks, bonds, and similar investments, and gains (but not losses)

On personal assets such as a home or jewelry. :

Social security number ;

322 | 12) 7997 *

a pe ee pee eee ee ae cectetnn een eee ne ee

‘ *b. ies
Oequirc
Fator tostor
oytabol (cco
inctructton

0, Cost of athor bosis, |
os odjustod (soo
motruction £) ond
oxpence of solo H

te
a. ‘to. doy, yr.
(Put dato sot’ ab6vo
dotted tino ond dato
ocquircd below
dotted Hoo)

§. Goin (or joa)

d Gioso onloo price (d foes o}.

uy, ihe ey roporty ond corse ion
PEG, i oharcs ae fan )

: y"

is
0 30
ah

*18

_ AS

. NW.88326~Docld:32245435: Page 830°. 2

“ey.
MQ),

ov

7 VE(0) Long-tarm eapital lons component carryover from yoars beginning before 1970 (soe Instruction H)
“12(b) Long-term capital locs carryover attributable to years baginning after 1969 (sea Instruction H) .

“ Ont linog 46(0) wad #1 0(b) and co to Part IV if locoes are shown on BOTH lines 12(a) and 13,

a " Entor your cliaro of ‘not chars: ‘term colin ‘(or lens) fram partnarships ‘and fiduciaries .
oF “Entoe, Ai Cala (or. foo), eembing linos 1 and 2.
. SHOCK

2 Nag host

Ye Bhtor (2 ‘lia af opplleatato'yronn | fino 4¢0)(39, Gorm 4797 (c00 Instuction A)

a enpltal 1930. component corryovor from yoar baginning, botoro 1970 {000 Inatructlon H)
Sherr: Cr eu: otal lacs" Gorryover att? sutobla ta yooro Boginning after 1969 (cod Instruction H) a

eg

oped. Lpaly” for foes), combl19 lines nag 2, 4{o) and Alb)...

‘orm G Gopial Gains ond “Lescos—13 ‘seats bald More Than 6 Months

eo

et, 9 ta dioteude

» Emtor your chara of nog long-term gain (or loss) from partnerships and fiduciavion . . Cs
2 Entor your, ghare of HER ‘Tons term gain from small business corporations (Subchapter 8). .
Not gain (cr (coo), combina lines 6 through 10. . .

Net long-term gain (or loss), combine lines 11, 12(a) and 12(t)

jy) j Summary of Paris | and __ . oe
Combine the amounts shown on lines 5 and 13, and enter the net gain or “loss here . a4 es _ 0) , .
Ii lite 34 chews a patie= a ;
(a) Etizor 50% of lino 13 or 50% of ling 14, whichever is smaltar (see Part VI for computation §5(a) .

of altornative tax). Enter zero if tncra is a loss or no entry on tina 13.

a Subtract line 15{a) from line 14. Entor here and on line 36, Form 1040.
f Rae 34 chews o baton

15(b) oo

Coe dackruesion hs
c& Gehorwlsy,: “y
da) Entar eno oft 10 following ameurto: boas
(i) Wf ameurt on line 5 is 2070 oF a net goin, onter 50% of amount on tino 14; nee fh ae
aR if amount on line 13 io zore or a net gain, enter amount on line 14; or, ; , we
© (ii), 4 amounts on line 5 and Jina 13 aro net losses, enter amount on line 5 added to 1G gt
50% of amount on line 13. . , 26@))_ pm
(by Entcr here and enter as a (oss) on line 36, Form 1040, the e smalier. of: |
(i) The amount on fine 16(a); Lo
7 (ti) $1,000 ($500 if m: arried and filing a separate return—if a ‘oss is shown on line | : |
. 4(a) or 12(a), see instruction M for a higher limit not toa exceed 131 000); or, i, 000 n0
: (iii) Taxable income, as adjusted (see Instruction |) 46 b) | Ic )
Carrvover (13,322.00)


Yoo

| SURuGe D. D. on Pryeecs Ry by

at WEEKLY WORK PLANSEIME REPORT

~

cnr ls ruta: va GB, las numnen £7 ~ Wi RK ENDING

oe tf M 5
t are COMME ANI

oe le = : mr coe
ae = Lo

5 wee OES

€

spills ‘Wet a _

; be g Be 08 $4 8 nan
th } Oy 2.2 Chiat.

a. OTF fn aie Bal =F a2

a on aioe _ pa
IS 5 | Re ! it i fas 2 Uk | ageh 33 _
oan i ca .
; =" eh ta)as +--+}

2.

<7
detr&

STN IAL

_ NW 88326, Docld:32245535. Page 84.) *


OS Giracasts BeEt Layenis

aan

Ry By

WEEKLY WORK PLAN/‘TIME REPOICT

saasions| A 1S, ication Qu. Tale. NUMBER WEEK ENDING SAGE EK

“CUSTOMER

v0) NAMES
coe te TUES.
; a a wef ot

“esd Eee g

4 MOR nl ap
Hican BOOKED COMMENTS At
% pre é EXPENSE
i ee
HR] + Wesvo™ ©
M4,

cai Men? 5 , Ia. a
— ane if

2

oh “i tM eiceat (_

NW, 88326. Docld:3 32245535 Page 85% ~- Saal

feo se q-Wy. 7K | ,

ott ? se. ia 10. me ih ie a2

en eer emer
ttrteh aterenne Ketan unenentnenrintne eeni armament

SAMVEL ay. ft. Phyecis £ uBy

WEEKLY WORK PLAN/’ yy RFEPOR I

ADF

“nusteen ( CLE. IES

7 _saLesMat Beete nad Ch.

QUSTOMER, =. Jak
| ' NAMB. -{esy
if he. Oh DEF, iM We

€ m

ee EN V4 a 2%
a Mf fl hy wh !
ONY Gee:
: ‘a Loon: ah 1 Git

TL 2 P24| aso! ll
Z| Pepa Saale Th

ce ley yO PP
ay . We i i ah
1nYs S$ feak “ ot :

ran “nt MOS

a4 Al

| 7951
oo sot-Z Bie | Ate

aye let? [ele | Bare |
Wendie Fe Ee _ mae ial oe ERD)

ns ee

: oo) “A Ay fs
. Pos er 20. La Si

» TOTALS

oN DOV EIEL Tanne WORE]

CALIFORNIA | AGE

INCOME TAR

boginaing . , 1972, onding
‘ LAST NAKA
auut

Your soelal soeugity nuabor 7

322 | 12] 7997)"

Wito's nurabcr, bY folnt eeicro
9 | te! 16207
eocu- as Sel Emap lo y Oe

paTIOn Wiifora Howpawh lo” * % _

8. B= Sedoa=-05 60 fice yeurcolf, your spouse or parson who Gualiiica you as is head of fisusoheld
, AIAOU Cecleds test cxica crd/er c4¢rcca IP dierent frac yours) — RELATIONSHIO |

LPead,. BeE ARs. BM A.3 TROMAG. : levees G4 ao
- meme tay

ZIP CODE

nprteremermmcersrce cane “nomen ee—cacweree
peepee apecnnecnennet sete dessunecceceaneesante so sarcueeeueenees soneneee ... Number > 5
6. Oiled (refer to instructions) “umber ‘of ‘blind exemptions claimed C> 6

» Jot Gopondont ond Ellnd onoragilans (add lines 5 and 6)

; ‘Atgoch Copy 2 of Form(s) wW-2 to
WO, cet es, clot rev omployoa ecnccsatica. een eaavallento, cltcsd expleacticn) 6 6. 6 ee

oan om We ro a evor F300, comztoto ond attech Schcdule 8(540)) .

ong ARO ee are i cedor S1GC23, @ad ton lo Yea Teblo ocd ontar oa Hao 17.
C2 Mca 14 Bs GIO,CCI or sore ecmpise tsa 19 cad 16. ;
‘gtoudond dedeettod Grom page 2, Wino 56) 0. 2... ; . we

2 Aout ‘ing’ 15 from Hag 24), Figure your tex on » thle cmaunt by ‘ng a corn Tos rato
Ni itor ton of ag u er La

‘at Tabla, ° - ‘B Tox. Ricvo Cencdule @ Oo Schiodulo "C1500)
f a . : Z

. oi sou $05, Married couple or “heed of houschold £50
o—Total on ting’ 7 above, A xB... a

ied (869 is 03 18 and 19)

: ate ‘ , ts 4 ;
oe Uae 2 file Te! a ee (rtbtract 4e9 0 from tino a re
SoA OAD BB, CF eae Ne Hrom page 2 Wine BY. ee
a «8, Rok tun Meltty (subtenet line 22 from lino 2)...

9 (see instructions—attach Schedule pIS.40)) .
(2 fino 23 and 24)

, AB Tan 6 ions
~~ 2B. Tete] ter Ce

; a8. etc). ce cy 29 teera “so clot (attcen Formls) W-2 ¢7 BE-2P to front)

. 27. 1002 Seimtuiota osttc.ck.d tat peynonts ,

ae 23, Gxeccs Gultiivata, Sul ton wfGhold (wttach Farm DE 1964 09 fea of rotutn)
, Tete) 0G 003 (utd "noo a, a7 and 2)... ee ee

1 lo opr Go 2, er CEE Py poet ib sg

" - ‘Molt raturn to P.O. Box 13-540,
She Te 29 Io lage finan “tna 8, enter Gi Sone, Gseramento, CA 95913.

. . hy
Les 7 8, ao i) to ib ‘a RPC, (Allow at loc “ot cht woots (er your refund)
, _() Credited on ‘1973 estimated tax... .

Pa “dear. that. t het ci cxbwainod this voters, Izates sdiag cecomeanying schedutes and ctatements, ond to tia Last of Gy beawiccca cod ]
at eonciote, HW ezeptrcd by o poreon otic thtn Roxpayer, hic deelcration ts bascd ea olf Information of tle ho hos ony teocitadge.

toy

hits wees

dase

Unser corstits of 27,
Calle? hb ts frwo, corres.

ene

*
4
id

3 s _ EDWARD L. LAMBERT

2 Ua Di "folatiy, BOTA anal tow Bute ee Gearon wala ee ye ee

La !

¥ ner Las ee alg NS earn “isis — ota .

S.d. bt 40-9527

NW:88326' Docd:22245895-Page8# ee ce


_.,

_ hye? Fora Scu (1972) F

besa [ofc of Gouschel¢—I claimed, answer | “the following questions —_ (See _Inciructions) Lo ie a

a Choely .£] Nover mareled (J Leget soparation (intorlecutory deroo doos not quelify) Dore

ORO Oo Widow(ar) Bato, a —_—,, [) Finel diverco/dinselution Date__________.. _ =

wacdvicl ea whe, quel yee, 2) hoad ef household @o no? Ile? this individual as @ dopondont on gago 1, line 5): Sate

. ina Cs es Rolationship__.... Age Did this person qualify as your dosiandloné tor
panes br ths & Forcen | scatsla in your hema for the entire tarable year? a not, ‘explain elreumnstone—3

code
: a ~ ott .

oe wale ta (ci loss) fon Cx ‘tomental Cohedule of Gains aad tosses tattech Sehadule . 1540) .

Joe 08 goin (or, tore! wand fines 34 ta) od le, we
we, cat gaauitiaa Phe . aan .
ral Fully taba posion eng ‘onnuitles (nat icaartod on 1 Schaduta Q. Lok ee

qD Alimony :.
L * 2) Othar ising
ao for vet

san too talhomontp plan, cM . . 2 rr rrr
Gieeue’s oa it af foro anc'éa pogo W, Hea BO

Diao £ 90 soparata rote7e3 C} crcyricd tanpoyera bath must Homlze dodesticas er both aust take the otondard deduction |

Sean) Cm seat ME 0), TE a

fier Sohytulo” AAO, Hina 4). Ce eg

uiieas (eos 8 “Hd ACG, Bh 28) a

wri opens? Gresa Souodula AGM HIng 29).

“yous Cue, iam Setodule A (540), ting 3 Ce ee ke ate

all, fad? tines GQ Grough $3) tee

YRS sete ) Pace ontcy .o atcaded dedueticn cf -

ay Wi shighe or marric:} gorsaa filing separate return Ce ee ee

j bed of bowed 7 OF migiri(3 Cosipto filing joing roturn a
wis sat on ap Acduction fiing 55). Entor taro and oa pego I, line 13.

thin a of. vee
9 4 tina 1).

ogy lcs ar

' a . ‘
boro cd a pago 1 Ning a. .

a4a00- 400 9-72 12.c0001 @ A ear

ie is \

7
Se y

GALIFORWG IA

WER Ue eUEvlOns

Bieccd fo Pena 849

TAXA DEE :

Coal Coy ensa

322 | 2a] 7997,

aoe Ruby

79 Ucéustten
cofuctica
1 Red end wha,

if one ssouse itemizos doducttons, the othor may cot use the Tox Tcble o7 eck
tha ctcadard ésduction. If you choose to itemize your asuctlons, complcto fit:
agzpropriata ttems blot. wos _ wih

vd bg Iesurcaed tet chomised for
13, Cet ate » RESTS
.

me a cues oe

wid

ewe,
wot wits |

+ es a f at 2 a Eat dlaronga

ale

29 eb na atl prc
wrod 0) Fs 2%

. mer C: Catt) “thea 44 iat 20, Gator -
4 ho cud 6H FCM LA). pero a toe abe

Goutidutions

22. Coahmelaciuding chet, rnonoy ot, ete.
@tomlza) 2... —

23. Total cash contributions 23 | oe eee veeeneceet
26, Other than cash (see instructions). Entor total °

Ree . 6 we if 8 a
99. Votri—(idd lines 23 and 24. Maximum daduction

08s Incorte.

may not exceed 2995 of cdjusted
p>

Enicr here and on Form 540, page 2

= es

Iekarast Exeonea ee aap

fo, Uomo mortqago . 6 eee te
G9. Anotaiimant purehacoo 4 + we ee et
BO. Biron Wtommbea) . . eeceecaecesescseaseessnawenannscuemsseee -

@. Tot lines %, 7 ond 2 28. Enter ‘hora and

on Form 5 540, page 2). 29

Meacollecsona Bodeaticas i

Ccsucky or Thott Loss(cs}—Sa0 lostrueticas

NOTE: If you hed mora then one casualty or theft
loa, occurrence, omit lines 20 through 33 and follow
inotrueticas for ‘quidanca,

£0, loos boforo odjusimonig... 6 ek
BY. Incyrcago rolmaurcomont , se ky ge
38, $1@9 Wenltation 2 6. ee ee te
99, Add Minos 31 ond 320. 7
34, Casualty or theft loss. (Line 30 fess lino 33

38,
30.

Ght™) Erro—Seo instructions .

Otor-—For education, alimony, unton cus, etc.
—S20 Instructions

ee
baa geenoneemmenmenesowes

¢

C sn 2 we Leo me er sete a

' luv. 1972)

NWE88326- Doclils32245535.-Page-89-———— ee

37. Totcl mlscoltancous ¢aductlonc~-Add tlnas 94, 35 so?
and 06, (Enter here ond on Form 520, payo ar | 37 ; ee
Solsodial D ex rovorso °
ig


CALIFORNIA

(Bene Ea . PROFIT (02 LOSS) FROM) CUS! INESS OR PROFESSION

Lalo Prcprtoterchips) i ~
a —— . — = _ _
: vecnedita to yer? cco aly Posts OCD ov DGENQ _ DovacoraNtoa, folce SOunurody Ooty Chey EI) 5 cote ar

Secla Tocurtiy fukcor

ae — 322 32i 7907

pes EE

AS rorvdeg ae PPODUER aero. seceseveernee cneneeeeon ccanecsennesonumenee

(Por onorieios rotell-horceroro, ‘wholosalo—tobacto; sorvicos ~logaly Taanufaciuring—-furnituros ated

seenceees  G

en cr eth wid for: “fal at o, eae
ne Lise ee csece saaea Go Podorol omployor icontifleation mumbar......c.-ssee eve enneecersenten snes

Wau ‘Nuya Ba Tvd. Von Nuys, Califormha ow je Leneencas soeeeececcesenateccemenanerenes

i ; : ere uatinge on ab eech; C) czerval; (] other. : irae
ia SOM Fe and £ fij< 400 (ne catchy year Sled Vit coqyired)? (] Yeo ff] No tN. a ofbe

tien of (iso eliy, town, ote. indicated? =. 6 1 1 ee Jy » EB Yos ‘(7 No
“6 Uh tans § joor? ve ee ee ee ee ee + GQ Ves (Bo

ales sauct b9.0% QMsd fa.

_—. borg roturns and ollowaneos &

: _ lino €) and/or operations (etiach sehodulo) .
fi wo! Ma see propariy (oxpiain’ in Sched c 3) . toe ee ee
30 rok bavi [rcpevly tee Ns ve re
2 beadulo’ 8) rer foe

=

nel clo 6 ‘on line 3, Schedule C-} Conclude any paid ta yourself) .

“ed aa-

CN RR Le

pane ‘ton’ (ie 73H Bh etonioa)
Otay aa end syomtesharlng’ plang (o00 Inotruetions for Wiad IS(a)). 6 ee ke
6“ arloyeo Man wp pregren? (ona Instructions ( for ling OY). we
190. GE oe én buetacn., tdobicda se ee
Feo dchis evitlag ion nalts \.t"egevleos a ee
! mie Jal “ea oO avra oe. a

ae (aie bavhiecs ci

‘ { to cacenenptetnane ssa ed ntammmeme genres smee 3 fey
| RS

(0) ai angen et pe

fp) Total bihor business expenses (add lines 19(a) through 19{0)) wee ee ke tk ek ke i

Total deductions (add lines 6 through 19) toe es Se ee ke ee ee an ho
a au, Net profit (or loss) (subtract fine 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR 6,969 40 .
{GQuv. 1678) . . . Pago q

NW?88326-Doctd: 99985535 Page96-————-—__—— anne mmr ve


aan

ac (Sina

CALIFORNIA ~

- —— ERAVAL QRS Lia LOSSES

Astash Co Vorca £3 of C4ENN om n,

4 :
5 tert fa ropart entan and tc2990 en stacks, bonds and dmiler “lavootacito

hh
ei ea) ui no eee) on For rca ¢ acesia oye @9 @ heino eo Iewolry.

rae Clas lag

Ealustct, cont C} Giict
quent taproveacs (i
not purchaccd, cries
qupfonation), tad ot
Lease eq? sctQ

b. Bato esacized &. Gress sales
price

(od (yd

oe Sa sone Depa ).- + seaman ee

‘ 5 »f SCHEDULE, Ar’ ACHED
ten! eet eT

o

Jeraprancas: p
H poms gy ,

vores ee ome yeoyonses

Ace si

pee enen es Abe sae cmemmannen eb
'

. . 1
ae abtutn, ad
eee ONS

Ae poveneusee new omen bedaenwenab

staceaubheaeeeahe

at CALL Wea a saiecthiga and &
“) CSIYOVEr feat proceding: tanable yeara (attach slatomom) . 2.4. -

(B20) me oh CC ay) r
ahha end Aductorieg 2 ee ke ye

3 ae i) rar! ;

eee tit ho ie eee Pee

Cobndulo DoT (840) (attach copy)
hGammorchtsond fduckaoa 6 ee ee ee ee
ci reyencr, trey) procoding fanetle yoaro (oitaeh sraiornont soe ees

ayy
nore eneeonmean parordenesedien

“SKE 192. 0m.

bee

Toaty

oF Fea C tinea’ 15 an!) too. te

an karo and en page 2, Part I of te Ora 520 or S4ONR 2 ww ee

at lina’ 4 47 shows o' loco, cover hicro Gad on page 2; Part It of Form 540 or SZONR the smallest of:

fe) on, syat on ling: VW... : ;

(bd) lic faxable ingore for’ ‘the toxablo your (computod without rogard to gins or lossos from tale or exchange
of capital asco)

( y gn 009 ($500 ba the ouey of a hyoband or wito filing @ Copsrata roturn) won . . .

SES Ta SGT “Ci, 322, 00). ;

Lo ae eR a ee eee AD ee eee ee ee tnt eee TE oe eens ane

ate
hoe

UNW 88326. Docld:32245535 Page 91


: Please print or type f

Write soc. sec. no. on Check or Money Order. Attach here 7]

la

Please attach Copy B of Form W-2 to back

atts

: ie >

7040 yy Department of the Treasury / - Internal Reventtie’Service ~~ et. (07
y . / é }
Individual income Tax Return } i
For the year January 1-Dacembar 31, 1971, or other taxable year beginning —...... oceans cessor, igrh ending .
First name and initial (I? joint rata, ute first names and middie initials of both: Last nama... wo Your sociat security. number
“SAMUEL AND, MYL [s : : - | RU . Se . 322 £12: 7997
“Present homa adcress (Humber and strea an cluding apartment number, or rural route) : . , , : : ‘ Fo : . : “Spouse” Ss social security number. .
16259 Bircher Street 00° ; Bh9
City, town of port office, Stain and 11? cote ‘ : { - Self Employed, ~
. : aa : on
— Graneda Wills, Californts ae : pation _Spouie's Housevite.
|. Fill ing Status—check only ane: Solos : - Exemptions oo 7 Regu jar 765 of over / ‘Blind Enter v oe
| 2 [] Single ce 7 Yourself Lo, BE) Oh tyme
“2 Gy Married filing jointly (even if only ‘one had incom) @ Spouse (yes “ii ten ir] mon Cc os | checked i
: ‘ .. . py h as Checked . Pi
3 (J Married filing separately and spouse is also filing. 9 First numes of your: dependent children who lived with
Give sp: use’s social secusity aumber in .
Space aiove and enter first name here ee “you ry ed, Brian, 2d isa a
4 [7] Unmarried Head of Household 7 —: *hends: ; .
50 Surviving widow(er) with dependent child 10 Number of cther dependents (from line 33)
& [] Married filing se arately 2 and t spouse | is tfiling “AL ‘Total exemptions claimed
. : ~
120 Wages, salaries, tips, etc. (Attach Forms W~2 to back. it unSvailable, attach explanation) ae
13a Dividends (8 pte )$.42, 50 wane 13b Less exclusion $... “hy 50. ct - Belance . Di. 13 wees
w - (ff gross dividends and other distributions are over $100, list in Part 1 of Schedule 8. » : .
& 14 interest. it $100 or less, enter total without listing in Schedule B ok ee | 14
o if over $100, enter total and lst in Part ti of Schedule B , . ob,

is income other than wages, dividends, and interest (from line: 40).

16 Total (add lines 12, 12.13 14 and 15) - Le

a7 Adjustments to income (such as “sick pay,” moving expense, ‘ete. ftom line 45) .

i a) 18. Adjusted gross income (subtract {i fine 17 from line 16). . :. " oe
See page 3 of instructions for rules under which the {RS will figure your tax, :
If you do not itemize deductions and line 18 is under $10,000, find tax in Tables and enter on line 19.
If you itemize deductions or line 18 is $10,000 or more, go to line 46 to figure tax.

19 Tax (Check if from:.(] Tax Tables 1-13, [1] Tax Rate Sch. X, ¥, or 2, se Sch. D, [] Sch. G or Form 4726) | 39 |

20 5 Tota credits (from line 54) 2... - .

‘24 Income tax (subtract lina 20 frora line 19) 2. ie woe
22 Other taxes (from line 60) eee

23 Total (add tines 21 and 22) Lae ey
24 Total Federal income tax withheld (attach Forms W-2 or W-2P to. back) : = 2

}.25 1971 Estimated tax payments (include 1 1970 overpayment allowed as a credit)
26. Other payments (fromline 64) .

| Tax, Payments and Credits

___.| 27 Total (add lines. 24, 25, and 26). oe cote ; :
og 1 tine 99 ie tare ee tee Ba = yy yi Pay in duit with return, Make check aa
8 z 28 If line 23 is larger than line 27, enter BALANCE DUE pen a ea site seek
me 29 If line 27 is larger than fine 23, enter OVERPAYMENT 6
GB | 30 Line 29 to be: (a) REFUNDED int mince = BP
! (b) Credited 09-1972 estimated tax. 0. -

31 Did you, at any time during the taxable year, have any interest im or signature or other author-
. ity over a bank, securities, or other financial account In a foreign country fexcept inaU.S. oo»
military banking facility operated by a U.S. financial institution)? . 7 . Yas No

if “Yes,"’ attach Form 4683. (For definitions, see Form 4633.) . Trt ee b ol ark

Foreign
Accounts

Under penalties of perjury, 1 dectare that } have examined this return, including accompany ng ‘ehedules and statements, and to the best of my knowledge and beet

t
- 7 iis trus, correct, and complete. ;
sien > __ es “EDWARD L, LAMBERT
ISM Your signature , _ Date spew ai preparer: SL eee J Tae Cate
ere ) : : : a . a alt information of hha jkionle :

88326 Docld:32245535 Page920

Pane 2 Form 1040 (1971) ~ Attach Copy 8 of Form W-2 here. Bb.

to - Ce een
-* “PART 1.—Additionai Exemptions (Coniplete only for other’ dependents claimed on line 10).
. CAME . “ (b) Relationship fe 3 tived in your hom (a} -Aniount Yeo ure; (fF) Amount furnished”
° 32 @ NAME Beene ni or deg dur wee a eee dep: : by OTHERS includ.
ae Sor D “. support. ff 109 g atite ing dependent. -
ALL.

=a

al
ao
aaa
i
mi

33. Total number of dependents disted above. Enter here and on tine 100. SO te mI

PART il.—Income other than Wages, Dividends, and Interest

34 Business income or (loss) (attach Sched ule C).
35 Net-gain or (loss) from. sale or exchange of capital assets (attach Sel rdule ‘Dy
36 Net gain or (loss) from Supplemental Sctredu! e of Gains and Losses tat tach, Form 4797)
37 Pensions anc annuities, rents and royalties, partner Ships, estates or trus ts, ‘etc. (attach Schedule E).
38 Farm income or (loss) (attach Schedule - FY, ee F
39 Miscel- ( (a, Fully taxable pensions and: annuities nnn ee : ie
, laneous (b) 50% of capital gain distributions (not re; vorted on Sehes tule 0)
. “ income | (cj State income tax refunds (caution—see instructions on page 7)
(d) Alimony . ee ; oad
(e) Other (state nature and source)... 3+. 0. 0s, ee

RSS
EWS :

SSS

nO Total miscellaneous income (add lines ¢ :9fa), (b), (©, (a). and )
40 Total’ (add fines 34, 35, 36, 37, 28, and 39). Enter here and aniline tS 2°.
PART lil.—Adjustments to income ~ :

41 "Sick. pay’ if included in line 12 (attach Form 2440. or other requted stateinent) om
.. 42 Moving expense (attach Form 3903) ... Be ee i a
43 Employee business expense (attach Form 2106-or other ¢ statement) .

44 Payments as a self- cemployed person to a retirement plan, etc. (altach Form 2950SE).
45 Total adjustments (add lines 41, 42, 43, and 44). Enter here and on line 17

, PART IV.—Tax Computation (Do not use this part if you use Tax Tables 1-13 to find your, tax.)

46 Adjusted gross income (from line 18) 3 wy 5 46 {6,529
47 (a) If you iternize deductions, enter total from Schedule A, line 32 and attach Schedule A a boa. |
(b) If you do not itemize deductions, and line 46 is: ce, . a [a7
(1) $10,000 or more but less than $11,538.43, enter 13% of line 46 rs ee —
(2) $11,538.43 or more, enter $1,500. ee nes ;
. Note: deduction under (1) or (2) is limited to $750 if married and fibng separately. :
- . 48 Subtract line 47 from line 46, : wy 48.
49 Multiply total number of exeniptions claimed..on | line 1), by $675. be ne oe 49
50. Taxable income. Subtract line 49 from line 48.00. 2 50

(Figure your tax on the amount on line 50 by usins: Tax Rate Schecdule x, Y or Z, or ‘if applicahbie, the “alternative-
tax from: Schedule D, income averaging from Schedule G, or maximum tax from Form’ 4726.) Enter tax on tine 19.
a RAH

PART V.—Credits _

51. Retirement: income credit (attach Schedule Ry
52 dnvestment credit (attach Form 3468)

53 Foreign tax credit (attach Form1116) ." ot oy
54 Total credits (add lines 51, 52, and 53). Enter here and on ‘line. 20

PART Vie —Other Taxes

55 Self- -employment tax (attach ‘Schedule St) - .
56 Tax from recomputing prior-year investment credit (attach Form 4255)" Loe
-57 Minimum tax (see instructions on page 8). Check here (i, if Form 4625 is attached
58 Social security tax on unreported tip income (attach Form 4137)

59 Uncollected employee social security tax on tips (from Forms W-2) we Loa
60 Total (add lines 55, 56, 57, 58, and 59). Enter here andon line 22 . 2 Ws tw

PART Vil—Other Payments ee eee ee ny

61 Excess FICA tax withheld (two or more employers—s fe instructions on page 8). ee ey
62 Credit for Federal tax on § special fuels, nonhizhway gasohne and lubricating foil {attach Form 4136) .

53 Regulated investment Company Credit (attach Form 2439)

64 Total {add lines 61, 62, and 63). Enter. here and on line 26 .

SE ORE De Ta a Ga” : : OA 14GG24

NW 88326 Docld:32245535 Page 93

Schedules AzB—It emized Deductions AND

"+ (Form 1040)

° Department of the Treasury: :
“Internal Revenua Service > Attach to Form 1040.
. Name(s} as shown on Form 1040

Samuel and Phyllis Ruby

- Medical z and dental ¢ expenses ; (not compensated by insurance
or otherwise) for medicine and drugs, doctors, dentists, nurses,
hospital care, insurance premiums. for medical care, etc.

“1 One half (but not more than $150) of in-

surance premiums for medicai care. (Be |

2 Medicine and drugs

Enter 1% of line 18, Form 1040

Subtract line 3 from tine 2. Enter differ

ence (if less than zero, enter zero)

5 Enter balance of insurance premiums for
medical care not entered on line 1

6 Itemize other .medical and dental ex
penses. Include hearing aids, dentures
eyeglasses, transportation, etc

i
sure to include in lina 10 below)... |

pw

7 Total (add lines 4, 5, and 6)

8 Enter 3% of line 18, Form 1040

9 Subtract line 8 from line 7. Enter differ-. ee
ence (if less than zero, enter zero)

_ 10 Total deductible medical and dentai ex
penses (Add lines 1 and 9. Enter here
and on tine 27, below.) >

Taxes. . : . |
11 Real estate !
12 State and !ocai gasoline (see gas tax - tables)
13 General sales (see sales tax tables) .

14 State and local income.

Dividend and interest Income

Schedule A—Itemized Deductions (Schedu e B on ack) -

4
- Your sacial security number

le s22 422 | 7997 |

i

Contributions. —Cash—inctuding ‘checks. money orders, ete,
(Itemize—see instructions on page 10 for |

examples) _ . ot a -

18 Total cash contributions... 9. 7. 0. |

19 Other than cash (see instructions on
page. 10 for required statement). Enter’
total for such items here.

20 Carryover from prior years

21 Total ‘contributions: (Add lines. 18,°

19, and 20. Enter here and on line 23,
beiow.)”

Interest expense.

22 Home mortgage.
23 Instaliment purchases
24 Other (itemize)_

25 Total interest expense {Add lines 22,
23, and 24. Enter here and on line 30,
below.) >

Miscellaneous deductions for child care,
alimony, union dues, - casualty losses, etc. .
(see i instructions. on page 10).

15 Personal property

16 Other

17 Total taxes (Add. lines 11 through 16.
Enter here and on line 28, below.) >

28 Total taxes (from line 17)

29 Total contributions (from line 21) .

30 Total interest expense (from line 25) .

31 Total miscellaneous deductions (from line 26):

iW: 88376 Docld:32245535 Page 94

Summary of. Itemized Deductions

27 Total deductible medical and ‘dental expenses (from line 10).

32 TOTAL ITEMIZED DEDUCTIONS. (Add lines 27 through 31. Enter here # ace on Form ‘104 4, line 47. ae

“26 Total miscellaneous deductions (Enter
here and on line 31, below.) « >

“80

ELS) 3h

“1 F617 | 68
500 lan-
ST aT


. A} or . _
NAME, eV CH Koes WA IDENTIFICATION pro Le PHD
ADURESS_ :
" SCHEDULE NO. : —._.__ SCHEDULE OF DEDUCTIONS. ——vear ENDED.
MEDICAL FEDERAL | STATE | CONTRIBUTIONS FEDERAL & STATE
1. ONE HALF OF MEDICAL INSURANCE ; CHURCHES oe - _
{NOT OVER $130.00) hs Q iva | to
‘2, DRUGS AND MEDICINES ee ee ee COMMUNITY CHEST/UNITED CRUSADE =: co,
[3 LESS: 1% OF ADJ.GROSS INCOME || SALVATION ARMY/GOODWILL INDUSTRIES
fenetonvesanm wees TY aes -
§. DOCTORS/ DENTISTS | XMAS & EASTER SEALS ae
DR. . HEART FUND/CANCER FUND _ an
OR PARTNERSHIP RETURN ee
DR. [oT PAYROLL DEDUCTION a
pR. OTHER ORGANIZED CHARITIES: a
DR. ~ woe
oR. Po,
oR. _
OR. -———
| _oR.
a INSTALLMENT LOAN —

“HOSPITAL ~ ——
“| LaBoraToRY +— ; ,
"BALANCE OF MEDICAL INSURANCE
NOT DEDUCTIBLE ON TOP LINE’

FEDERAL & STATE|

TRAVEL FOR MEDICAL a MISCELLANEOUS DEDUCTIONS
AMBULANCE. PT atimony (EXPLAIN)

SAFE DEPOSIT BOX FEE

__SLASSES

| tT
HEARING AID | ff | __UNION QUES
+ PT sw
j

; SMALI. TOOLS. (e000 1 1 YEAR)
, LESS: REIMBURSED BY INSURANCE | | sarery equipment
. [6 TOTAL _ |_| UNIFORMS (NOT GEN. WEAR)
EAE sees mamas LAUNDRY & CLEANING

8. BALANCE (NOT LESS THAN ZERO) ; AUTO "MILEAGE @
9. TOTAL MEDICAL DEDUCTIONS. TELEPHONE EXPENSE (NOT REIM
EMPLOYMENT AGENCY FEES

(LINE 1 PLUS LINE 8) — j ATO Je a e
LTAXES a ; FEDERAL STATE DUES & SUBSCRIPTIONS

AUTO LICENSE (LESS REG. FEE) : INCOME TAX PREPARATION
SALES TAX 00 | || orners

SALES TAX AUTO
REAL ESTATE TAX C77

PERSONAL PROPERTY TAX

| {STATE INCOME TAX

GAS TAX /O) cat.@ s{)) ¢Gal.

i

SUB TOTAL
_ DISABILITY INSURANCE LESS REIMBURSED BY INS.
MISC, TAX -xx [x x [ | = - SUBTOTAL | Zr Ip

LOTHERS: | Paes stn Fon cach casey | eo I
|__| || TOTAL CASUALTY LOSSES | a @ |

_FEDERAL STATE _

| TOTAL TAXES! Jd gil aYpir) ___ TOTAL DEDUCTIONS | G/OO9) Gry, nee

NWEES3 267 Hogi; 372455235, Page, 16622 VFNTHRA RONIEVARN cIIITE RIN FNPINA CALIFARNIA 012148


me

———

Profit {or Loss) From Business or Profession |
{Sole Proprietorship) ; : VOR.

BP eoartinent of tha Treasury > Partrierships, joint ventures, etc., must file on Form 1065.

Internal Revanue Service & Attech to Form 1040. .

Name(s) as stiown on Forin 1040 .. . . Coe, . i
Samiel and Phyl ts Buby oo ee |

Social 1 number

322 22 E 2997.

A Principal business activity .. Food | Service : eee Product 0 2 eee ee eee ae Sl eledeldeecede ete
(See separate instructions) , (For exainple: retait— hardware: wholasala—tobaces: services——legat: “Jnanutacturing——farniture; ete. )

B Business name Snack Rar ce leceeeeeeeeeee c Employer identification Number leeeeee Loe celacnececceceenececces ence _

Van “avs, California 91401 :

D Business address - pee deeee ce see hte oes .
E indicate method of accounting: Ox cash; “(2) fa acerua!; (3) Tj other, re : {ZIP code).

F Was there any substantial changa in the manner of determining quantities, costs, or, valuations between the opening and clesing inventories?

CU YES [§ NO. If “Yes,” attach explanation. ” :
- G Were you required to file Forms 1096 and 1099 or 1087 for the calendar year 19712 (See “lem Gr in separate instructions for Se hedule co)

C] YES | NO. If “Yes,"’ where. were they filed? D>

:
;

1 Gross receipts or gross sales $. 0. Less: Returns and allowances Bonet et steeecee cere

2 Inventory at beginning of yaar (if different from dast years closing inventery - . .
attach axplanation) ,

3 Merchandise purchased $.

, less cost of any items | : Coa . 1.

Ro. a

withdrawn from business for personal use $.
4 Cost of labor (do not include salary paid to yourself) . . . SCHED
5 Material and supplies . . . . 2 ee 7 ATTACHED
6& Other costs (explain in Schedule C-1) . . 1. ee ee ee a
"27 otal of lines 2 through 6 2.
8 ‘Inventory at end of this year ©. 6 te ee :
9 -Cost of goods sold and/or operations (subtract line 8 from line 7) .~*. oy 7
- 10 Gross profit (subtract ine 9 from line 1)... me

OTHER BUSINESS DEDUCTIONS
11 Depreciation (explain in Schedule C~2)

12 Taxes on business and business property (explain in Schedule C-1). _ .

13 Rent on business property 2. 6 ee ce

14 Repairs (explain In Schedule C-1) . . ae
' 15 Salaries and wages not included on-line 4 (exclude any paid to yourselt) - rs oe ans Dealt
WG-Insurance . 0. ek ek ee we ee ee _ lace veeeepeteecesaeterefeccead
_17- Legal and professional fees ©. 2. ee eee : Lo oo! :
18-Commissions .°. . 2. . es - - a 7 ; ,

19 Amortization (attach-Statement) 2. 0-2 ke ee te et Peete soeeceeceedncened °

20 (a) Pension and profit-sharing plans (See instructions). eo

(b) Employee benefit programs (See Instructions)... . a
21 interest on business indebtedness . 6-00 eee ee ke ee
22 Bad debts arising from sales or services . a

23 Depletion «> a SG

24 Other. business expenses (explain in Schedule C-1) ye - a

25 : " Total of lines 11 through 24 . 2. 1... Soe ee te ee weve

26 Net profit (or Jose} (subtract line 25 from line 19). Enter hare and on line 4 Form 1040. ALSO enter on | .
Schedule SE, Part |, lina boo. 1. . re 350 7

Amount’

_ SCHEDULE Ci. EXPLANATION OF LINES 6, 12, 14, AND 2a ot J

“Explanation


. Samuel and Phyllis Ruby
SUPPLEMENT TO SCHEDULE C:
a

Income. _ Bee _ vs 7 rea 343,479.18.
Less: Sales Tax SO we ‘1746.63
. . . a 843,394.55 =

Cost of foods Sold . ; oo,
Ber innine Inveatory Lo. ; ; Te, oe So 800.0
Purchases oo ws ans
Reverage/milk Co ; , Se 4,980.70
Groceries, § - oe 5, 169,50 |
_ Meat. . ; oo, an _ 2,570.35 -
| Bakerv/hread _ So os 8815402
Total Avatlable . ; ne . $26,336.17
"Less: Ending inventory =... a 800.09 (25 516, 17

Saran

Adjusted Gross Profit, | “su, 768,38

‘Expenses . a a, . a :
Casual labor 2 ee See
“Rent re - nee 1,459.87 =
Payroll a 077

. Telephone Lae. OO 0
Insurance ‘190.50
Accounting =~ ee oO es gg age

. Miscellaneous ‘ te Se ee 27,04 oo
‘Equipment: ey 74,03.
Maintenance/repairs: - 136,19 —
‘Taxes/Licenses. oe . Lo. LE 556,06 07
Hostery— . : po fe Be 130.04
Auto ee oo ae oo. TA
Linen. ee e783

Donations 9. et a ao By 9 55°

Se oe - re Ssh 778832
- Less: Peprectat ton 7 ; _ io 7 - arenas , 3, 428550)
MET PROFTT © a re Sg a 5033"
DEPRECIATION

Equipment 4/70 © $19,990.09. $2,90N,n0 2 5 HE, st $2,900.00
’ Covenant not SO St a ee Se Cee
to Compete 5, 000,00 1,000,900. S¥r. SL... 1 an0.00°
Leasehold Imp, 3,900,009 A28,50° 2 Pel so yg 50
(Ral, of Lease) So . Se ae oe :

$4,428.50. 5°

W 88326 Docid:32245535 Page 9f


> [hibast Revenue serves,” | B Attach to Form 1040.

SCHEDULE SE Computation of Social Security Self. Empi oyment Tax |
{Form 1040) oe

> Each self-employed person must file a Schedule Sh.

internal Revenue Service

> If you had wages, including: tips, of $7.600 or more that were Subject to social. Secunty taxes, do not fill in “this page.
> If you had more than one business, combine profits and losses froin ail your businesses and far ms on this Schedule 2 SE. _

Importar . ne self. employment income reported below will be credited to your social security, recoid and used in figuring | social ‘sec :
Name of self. -empioyed person {as Shownon social security card) - . : en - 7 Social = security - number
: , : . | of self-employed person

o we - Mo, , 39 t [2.1796
Samuel Ruby : i : ; ae . 322 £2. i 7997

Business activities subject to self-employment tax (grocery store, restaurant, farm, etc.) Db |

“EE Computation of Net Earnings from BUSINESS Self-Employment (other than farming)

Net profit (or loss) shown in Schedule C (Form -1046), hae 26. (Enter combined amount if more than’ one 7,3: 50} 33
husiness.) 2 rr pb :

2 Not income (or loss) fron exciided senaces of sources included on. lee 1 Lo — TET
Specify excluded. services: or SOUurceS . neo. Leetede , 2ole. seet recente!

3 Net earnings (or loss) from business self. employment (Sub btract tline 2 2 from tine 1. and Wt here and a oT 3 50) 33°

on line 8(a). Part Ul below.)
i Computation of Net Earnings from FARM Sell. Employment . a
A farmer may elect to compute net farm earnings using the OPTIONAL METHOD (line- 6, below) ‘INSTEAD OF THE REGULAR
METHOD (line 5, below) if his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600."

If your gross profits from farming are not more than $2,400 and you elect to use the aptional method, you need rot complete : eo
. lines 4 and 5. . . . : . 7

Computation under Regular Method | So ; | ae :
4 Net farm profit (or loss) from: : ; :
(a) Schedule F, line 52 (cash method), orline 71 (accrual method) .
(b) Farm: partnérships. ‘ : . :
"5 Net-earnings from self- employment from farming. Add, tines Alay and Hib)
a - Computation under Optional Method - ; c: a
6 AV gross profits from farming are: ° ; : rn harran 7
* (a) Nat more than $2,400, enter two-thirds of the gross’ profits ee re
(b) More than $2,400 and the net farm profit is less than $1,600, enter $1, 600

*Note. —Gross profits from farming are the total of the gross profits from ‘Schedule F, line 28 (cash.
: method), or line 69 (accrual method), pius the distributive share of Bross: profit from farm
Partnerships as explained in instructions tor Schedule SE. L,

7 Enter here and on lite. Cb), Part Ill, below, the amount on line 5 5 (or line 6. if you use. the optional po
method) - eee :

Computation of Social Security Seif. ‘Employment Tax .
Net earnings (or loss) from self-employment— — i
(a) From business (other than farming) from line-3, Part |, above ~
(b) From farming (from line 7, Part ll, above) ; .
“(c) From partnerships, joint ventures, etc. (other than farming) wee: - woe.
(d) From service as a minister, meniber of a religious order, ora Christian Science pre actitioner If you : Q
. filed Form 4361; check here {j and enter zero on this line’ Se Load

@

(e) From service with a foreign government ¢ or international organization |
(f) Other. (director's fees, etc.). Specify
-9 Total net earnings (or Inss) from self- employment reported online 8 . |.

t
(If line 9 is fess than-$400, you are not subject to self- -employment. tax. Do not fa in rest of page)

.10 The largest amount of combined wages and self. employment earnings S subject aa a | ,
. tosocialsecuritytaxis . . .. : a rs i |

11 (a) Total “FICA”’ wages as indicated on 1 Form w-2 i
(b) Unreported tips, if. any, subject to FICA tax from

Form 4137, line 9 .). cr

. (c) Total of lines 11(a) and 11(b) . a

12 Baiance (subtract tine 11(c). from line 10). ; — a oe

13 Self-employment income—line 9 or 12, whichever. is. smaller to.

14 If line 13 is $7,800, enter $585.00; if fess, multiply the amount on line 13 by. 075 . . woe,

- 15 Railroad employee's and. railroad employee repres sentative’s adjustuient for hospitaki insurance © benetits hoe

tax from Form 4469 . ow. Sy ote ae _

16 Self-employment tax (subtract line 15 ‘trom line 14). Enter he “en anion 1 For J

ais lis

W 88326 Docid:32245535 Page 98°

&
r.
g
bi

a (Form 1040) mm Attach to.Form 1060. Examples of property to’ ‘be reported on this Schedule are
’ : gains and losses on stocks, bonds, and similar investments, and gains (but nat losses)
on personal assets such as a home or jewelry.

SCHEDULE D Capital Gains and Losses pee pow |
|

Internal Ravenua

Nama(s) as shown an Farrn 1040
Samuel and Phy liis Ruby

Short. term Capital Gains and Losses—Asseis Held Not More Than 6 Months

boH ¢. Mo., day, yr. 7 a : ~ H ‘a. Gost or “other sasis, |
sat ey {Pat cate sob aboea — | seeuout impraverents | Gain or
a bind of Bop an nee oO j anes fatter j- dotted ling and cata” Gross sates Be eee ichaer attach : ofa or floss)
: symbol (see | free Gel om | explanation) and ex- : : :
| Instructions) | dottad linny
_ vee coe wl - :
SCHEDULE: ATTACHED
1
2 Enter your share of net short-term gain or (loss) from partnerships and fiduciaries . 2 ;
‘3. Enter net gain or (loss), combine lines land2. . ... . - soe {3
4(a) Short-term capital loss component Carryover from years béginni ng + before 1970 (see Instruction 4 | Ala):
4(b) “Short-term capital loss carryover attributable to years beginning after 1969" (see Instruction H) ~. f 4(b)_
5 “Net short-term pain or r (loss), combine | lines 3, 4(a) and 4 ACD) es _— cel 5 _
ale Long'te term Capital Gains and Losses—Assets Heid More Than an 6 ‘Months .

7 Capital gain. distributions ee ele

a _ Enter-gain if applicable from tine A(ay(1), Form ‘4797 (see lristruction A).
9 Enter your share of net long-term gain or (loss) from partnerships and fiduciaries oe
10 Enter your share of net long-term gain from small business s corporations (Subchapter $)..
11 ‘Net gain or (loss), combine lines 6throughio. ... . : . : ’
12(a) Long-term capital loss component carryover from years beginning t before 1970 (sée Instruction Hy. tava)

5

=

12(b) Long-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) :, - | 12(b) oe _
13 Net Jong term gain or (loss), combine lines 11, 12(a) and 12(0) we ee kt 131 ¢

Summary of Parts | and ii |

15 If line 14 shows a gain-—..
(a) Enter 50% of line 13 or 50%, of line 14, “whichever i is smaller (see Part vi for F computation of
alternative. tax). Enter zero if there is a loss or no entry online 13. . : 15(a)

. = (b) Subtract line 15(a) from line 14. Enter ‘here and on 1 line 25, Form 1040 . a o - _ _ | 15(b)
16 ~ If line 14 shows a loss—See Instruction 1.
; b> Omit lines 16(a) and 16(b) and go to Part IV if losses. are shown on lines $ 12(0) and 13.

> Otherwise, ; of
@) Enter ona of the following amounts; - a ; 2d
(i) If amount on line 5 is zero or a net gain, enter 50% of amount. on nine 1 14; a ef
|

140 : . Combine the amounts shown on lines 5 and 13, and enter the net gain. (loss) here coe ay | 14 “ia as, 8a i

ia

‘(i)- df amount on line 13 is zerd or a net gain, enter amotunt on tine 14: or,
* (ily if amounts on line 5 and line 13 are net losses, enter amount on ‘Tine § added: to
50% of amount on line 13. . . rer . .

“(b) Enter here and on line 35, Form 1040, the smatier of:
(i) The amount on line 16(a); , .

(i) $l, 000 ($500 if married and ‘filing a separate return—if losses are shown on Tines
4(a) and 5, see Instruction K for a higher limit not to exceed $1, 000); or, :

(iii) Taxable income, as adjusted (see instruction J) wo. : :

ao
16(a)| fe
fe

a :

: . Cavewe ver ny SLA, 522.09) i

W 88326 Docld:32245535 Page 99

. ag oo oe ra
TERA LER LAP te, iberecl varef
VEEKLY WORK PLAN/TIME REPORT ye a
j PEI ON pm :
LE SNUMBER ZF OT coc Sic ex
REVENUE

“BOOKED _

1 shy

‘

. wed fe
REZ pep FG |
"CALL _
HRs | COMMENTS ayo
EXPENSE
NOTES |

= =F

CUSTOMER
NAME

oa

Veer ei pPiey, eeaSil dl [TT EE ge Peep op
y, eA oy
ELI PN OX, a

arth é Zane
| ff
a


Co 5 id
Bisel ioli
map WEEKLY WORK F

Des py
ny Rae YD dys

TIME REPORT. |

Eft

CONTRACT | 7%, REVENUE "1 ALi

& “0 /WEEK ek DING!
;

- SALESMAN”

' CUSTOMER 3 i ne "+ BOOKED ERS COMMENTS AND
_ : : "EXPENSE -

- NAME nee
NOTES

BO

. 2 vo
bt cn fh Oe

;

Reene

5

prere D OPEL

TOTALS |.

W 88326 Docld:32245535 Page 101

War Leaepci b De
WEEKLY WORK Pi. ne TIME REPORT

SALESMAN AS CC Ce psaigg of, Noynnze:,
— be REVENUE. a oe
CUSTOMER. . ; “  Rookep:) ) | -COMMENTS AND
NAME af oo . ob EXPENSE .
8 MONTHLY | HB] +- NOTES

~ j ; one vey os a . , oi I. . ° re? . . m,
wane: Rid i vel - Lo rity Weiser aps

ed |
Phewcehs \yieo| | | TT ben

W.88326 Docld:32245535 Page 102

SLA LA se . MOY ETP PR ey.

VAJFEK ENDING Lo
REVENUE
BOOKED

COMMENTS ANE!
; EXPENSE -
“NOTES °

CUSTOMER
NAME

Se (ee=)
ae PtP tty ee)
PT —
po tT TT —

5 Vergy Co dsac | :

“NW.88326 Docld:32245535 Page 103

er.

TAXA | TAXABLE

a lr OTT,
CAPITAL GAINS AND LOSSES. ee ee eee

Attach to Form 540 or S4GHR o

~ &
SCHEDULE |

Use this schedule to report gains and losses ‘on stocks, bonds ‘and. ‘Similar investments,
_ and gains (but not losses) on personal assets such as a home or iewelry.

Name as shown on Form 540 or 540NR T ~ Secial Security Humber

Samuel and Phyllis Rubv . 7 - . | 322 i429 2997 "

SHORT-TERM—ASSETS HELD NOT MORE THAN 6 MONTHS

- . . - . — .@. Cast or other basis, as oo
. , a adjusted. cast of ' . :
fa. Kind of prooerty and description , b. Dale acquired c. Date sold : - ep Sept ” subsequent improvements | f. Gain cr loss*.*
 (Examale, 100 shares af “Z"" Co.) : (mo. day, yr.) | ¢mo., day, yr.) [4% Grass sales price

attach explanation) °

Cif not purchased, | (a tess e)
- and expense of sale :

eee

“SCHEDUL Fe At TAG nen

i 7 2. ‘Enter your ‘share, of net short- term ‘gain 1 (oF ‘loss) ‘from partnerships “and fiduciaries
"3. Enter net gain (or loss), combine lines } and 2... . . ; woe 7 Fe ee
4. Enter unused short-term capital loss carryover from preceding ‘taxable \ years {ottoch stotement) : :
5. Net short-term gain (or loss), combine lines 3 and 4 :

LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS

Enter gain if applicable from ‘line 4 “Schedule ‘D- 1 {Form 540) ‘(attach copy).
8. Enter your share of net long-term gain (or. loss) from partnerships and fiduciaries o rs :
9. Net gain (or loss), combine lines 6 through 8... st te a ee

10, Enter unused long-term capital loss carryover from preceding taxable years (ottach stotement) Cae ek 14 s als GIs

11, Net long-term gain (or loss), combine lines 9 and 10 .
Se Sac
_ £15,522.09)

30

12, Combine the amounts shown on lines 5 and W and enter the net gain (or loss) here. ..-. . an Ta.
-13. If line 12 shows a gain— ; ao. ae .
(a) Enter 50% of line 11 or 50% of line 12, whichever is smaller. ‘Enter zero if there i is a loss or no entry on n tine YW
(b) Subtract line 13(a) from line 12. Enter here ond on line 32, Form 540 (line 33, Form 540NR) ‘
_ 14. Mf lina 12 shows a loss-—-

(a} Add tines 4 and. 10 (if lines 4 Hand 10 are blonk, enter a zero here and on lines + 1b) and 14(c) ond go to
line 14(d)). vo ee ee a

(b) Combine lines 3 ‘ond 9—if gain, enter gain; if loss, enter zero. . ; . a , .

(c) Enter smallest of- (i) ‘fine 14(a) less line 14(b); (ii) the amount of toxoble income on Form ‘540 or 540NR, :
computed without capital gains and or losses—determine this figure via a side computation; or. (iii) $1,000:

(d) Combine lines 3 and 9—if loss, enter loss; if gain, enter zero here and on line 14(e) and go to line 14(f)

(e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital cyains
and or losses, tess line 14(c)—-determine this figure via a side computation; (ii) $1,000 ($500 if married and
filing separately); (iii) if line 3 is zero or shows a gain, 50% of line 14(d); (iv) if line 9 is zero or shows o .
gain, amount on line 14(d); or (v) if lines 3 and 9 show losses, line 3 added to 50% of line 9 .

(f) Enter here, and on line 32, Form 540 (line 33, Form 540NR}, the sum of lines 14(c) and Mee not |

enter.an amount greater than $1,000) .

€ 1,990,090).

\

2.00)"

, oo carr: O° ver 4). (14,5

, are
: Sen tnstructions on Back | Loe a - o . oe

W 88326 Docid:32245535 Page 104

DWIDUAL COME TAX eTURR .

WD

For Calendar Year 1971
or Fiscal Year Begun

1971 and Ended

ce
each
es
: end
woud

FIRST NAME(S) AND tNITIAL(S) LAST NAME Snause’s social security number :
pease SAMUEL AND PHYLLTS RUBY | 329°: 12/7997 | 349 4 18) 1429
Type PRESENT HOME ADDRESS (Number and street,-or rural route} Your oe | “Spause’s oceusation

16250 Bircher Street
CITY, TOWN OR POST OFFICE
“Granada Hillis
NAME AND ADDRESS OF EMPLOYER AT TIME OF FING
Selif Employed ;
FILING STATUS—Check Only One:
1. (J Single
2. CE Married, filing joint return

“4. OO Married, filing separate relun-—If this item shecked, enter spouse's
social “security number in space above and enter first name

“or
Print

“Self Emploved
| COUNTY ae
‘| Leas Anceles’”

ZIP CODE

STATE
California

| BLIND and/or QEPENDENT EXEMPTIONS: a ;
i 5. Blind Lf Yourself (Your spouse -Enter nunibar of boxes checked

6. Dependents—- Us not ist yourself, your : spouse, or person who qualities you
as head of household NAME ¢and adiress if diferent from yours) RELATIONSHIP -

RBretan FE ‘lisa,

Claim your appropiate
eyemption on line 16

Thomas". : .
! Slip leeeeheetee Eta

number

‘Fred,.

here > | - Sees | Cecceee crete ne ce dee gen een ee one TeneeeTbeadhesesanyesete seneneectanee ote
4.0 Unmartied head of ‘household’ “Complete P Part thy page 2. "| 7. Total-blind and dependent exemptions (add lines 5 and 6)

Do not » write:

. Tax on preference income (see instructions) check here (), if Schedule: P (540) is attached -.
. Tota! tax liability (add lines 23 and 24) : .

. 1971 California estimated, tax payment (include 1970, overpayment allowed as a credit) - oe, .
PAY IN FULL WITH RETURN

Balance: ‘27. Balance due—if any (subtract line 26 from line 75)
en 28. Overpayment—if any (subtract line 25 from line 26) - OVERPAYMENT
29. Portion of line 28 you wish to apply on 1972 estimated tax . Oo

. Refund—if any (subtract line 29 from line 28). . ...

. REFUND

Ys
in peyaities of perjury, 1 declare that I have examined this return, including accompanying schedules and stalements. and to the best of my knowledge and
vel it ts true, correet and complete. If prepared by a persea other than taxpayer, Ais declaration is based on all information of which he has an Knowledge.

(8. Wages, salaries, tips, ete, (before payroll deductions) ite mote than two, employers, attach list S in: this. coliss -
Income . Emoloyer's name fi - Wheee employed: (city, and " state)
i 9 Dividends. _ Enter total here (complete and attach Schedule B (540), if, total is over $100) .~ :
. 10. Interest. Enter total here (complete and attach Schedule B (540), it total is over 3100)”
& 11. Other incoma (from. page 2, linn’ 40) sed
ud 12. Total (add tines #, 9, 10 and 11) ;
7 = 13. Adjustmonts to Incoma (fram paye-?, linn 46)
Pr 14. Adjustad gross Income (subtract line 13 from line 12) . woe .
= © If you do not itemize deductions AND line 14 is under $10,090, find your tax in Tax Table in instructions. Enter tax” on tine 15. -
=. © {f you itemize deductions OR line 14 is $10,000 or more, go to Part IV on page 2 to figure tax. Enter tax on line 15. .
3 15. Tax from (check one): (j Tax. Table, [y Tax Computation (page 2, Part 1V) or (] Schedule G (540), line 21 25 .60
rE 16. Personal Exemption. Single—$25. Married couple or head of household--$50 “TI fe Lg
= Your iM. Multiply total number. of exemptions on line 7 above, by 38
Tax, 18. Total exemptions (add lines 16 and 17)
and _--‘19, Tax liability {subtract line 18 from line 15—not less than zero) weseeeeeele ee
Credits 20. Other credits (from page 2, tine 62)
21. Net tax (subtract line 20 from fine 19) . oar
22. Tax torgiveness—20% % of line 21 (use Part V on page 2: it reporting i income on 4 Schedule 0 640 a 22
a NOTE: You must file your return and pay any tax due (line 27) by the due date to be entitled ta this: forgivenass
23. Net tax ability (subtract line 22 from Jine 21—if $1.00 ar less, enter wo 0 a FOB  Ee
24

Do not write tn these spaces

Sign >
here D>.

aan Your Social Sacurity No..on Your Chock or Monay Order. Make Remittance Payable to
ANCHISE TA Mail to FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95867
W 68326 Bold s22888 Pax Page 105 ;

Your signairecit filing jini, BOTH must sign

Address

Spouse’ . ‘Signature annie |


: 2) a, Form 540 1971 Page 2

PART. t—Head af Household—If claimed, answer the foitowing questions (See Instructions)

[Check .[} Never married -_ ; "7 Legal separation (interlocutory decree does not t qualify) Daten
“one: [7 Widower) Date, ° . So... AC} Final divorce/dissolution ‘Date : : . .
. , Individual who qualified you as head of household: oo,
: Name. 00 voeeeaeees Relationship ; _ Age... . Gross income $... cee
i _ ds this person married? 0. IF yes, di d he « or + she file a joint return with spouse? _. a “Did this person, 4 qualify as your dependent for.

the calendar year 1971?.... :.Did this person reside in your home for the entire ‘taxable. year?

lf not, explain circumstances. _

“Tote! amount. necessary tc maintain household $0... 0. mo “How much did you > contribute? $...

PART I—Other Inceme -

31. Business income (ar loss) (attach Schedule C (540)) . 2 2. Foe ee Te
32. Nat gain for ioss) from sale or exchange of capital assets {attach Schedule D (6409) :
33. Net gain (or loss) from Supplemental Schedule of Cains and Losses (attach Schedule 0-1 (540))
. Pensions and annuities . : oe ee
. Rents and royalties o [ Attach |

: : Schedule £ .
. Partnerships ; (Form 540)
a7. Estates and trusts . .
. Farm income (or toss) (attach Schedule F (540))
(a) Fully taxable pensicns and annuities (not reported on ‘Schedule
| Miscel- (b) Alimony. .

langous (c) Other ‘state nature and source)
income

: ' (d) Total miscellaneous income add lines 39(a), (b) ‘and (c)
’ 40. Total (add lines 31 through 39). Enter here and on page 1, line 11 =

‘PART IH—~Adjustments to Income.

, AL “Sick pay” if included in line 8 (see instructions—attach -statement)
. 42, Moving expenses (see instructions—attach statement)

a 43. Employee business expense (see instructions—attach statement)

44. Military exclusion (see instructions for line 8) .
. Payments as a self-employed person to a retirement plan, etc., ‘attach Federal Form 295086) i
45. Total adjustments {add lines 41- through 45), Enter here and on page 1, line 13

PART \V—Tax Computation—Do not use this part if you use the Tax Table to find your tax

“47. Adjusted gross income (from page 1, line 14)

48. (at If you itemize deductions, enter total fram Schedule A (540), line 32, and attach Schedule A j
 {b} if you do not itemize deductions, and line 14 is $10,000 or more, enter :
(1) $1,000, if single, or married person filing separate return’ .
(2) $2,000, if head of household, or married couple filing joint return -

13, Taxable income (subtract line 48 from line 47). Figure your tax on this amount by using”
- appropriate Tax Rate Schedule in instructions. Enter tax on page 1, line 15 .

. Complete all fines belaw. However, if you used ihe income averaging method to compute your tax on- tine 15. emit tines 50.
PART V—Tax Forgiveness §1 and 52, enter on fine 53 the amount shown on. line 41 of Schedule G (540), and complete. lines.54. 55 and 56. \-

50. Tazzble income from line 49 above, or page 1, line 14 if Tax Table used

3. Amcunt (if any) entered on Schedule D (540), line 13a)

52. Adjusted taxable income Asubtract tine 51 from line 50)

33. Adjusted tax (use same method. as used for determining tax on page 1, line 15)
- Adé lines 18 and 20, page 1; and enter total here

. Adjusted net tax (subtract line 54 from Jine 53).

: 20% of tine 55. Enter here ‘and on page 1, line 22

57. Inczme derived from sources within State Of ee ceneg tng and also taxable by California.

$8. Cati foraia adjusted gross income (from page 1, “line 14) Dake ae

$3. Catifarnia. tax: liability (from page 1, Tine 19) a
2 Credit limitation—line 57 = line 58 2.2 % (100% maximum) x fine 59 (cannot exceed tax paid ather state) -

34 Retirement incame eredit (attach, Schedule R (540) © co ,

ot. Totet (add tines 60 and 61). Enter here and on page , line 20

ART AT Vil—Reconciliation to Federat Return—If adjusted pross income on Federal Return is “different trom ‘ine. 14, 14paps 1, explain be below

a -
si72a.ann a.71 12 ocem () A o8P i

«TBE voenicientse95-Page-t06

SCHEBULE

©) CALIFORNIA

ITEMIZED DEDUCTIONS =

Attach to Form 540

Secial | Sesurity Number
32242! 79

Itemized 45. stondard Deduction—You have a choice between two deduction if one spouse itemizes deductions, the other may not use the Tax Table or cia;

metheds. You can either itemize your deductions or take a standard deduction as ~ the standurd deduction. if you. choose to itemize your deductions; complete tr
explained in the 54Q Instructions. Qn separate-returns of a husband and wite, appropriate items below. . .

edical and dental expenses (not compensated by insurance or otherwise) for medicine and drugs, doctors, dentists, nurses, hasta care, insurance ©
— premiums for medical care, etc. . . : :

1. One half (but not more » than $150) of insurance premiums for medical care, 7 Lee a wo [1 |
2. Medicine and drugs ; , ;
3. Enter 1% of adjusted gross income “shown on a Form 540 .
4. Subtract line 3 from line 2. Enter difference (if less than zero, enter zero)
§. Enter balance of insurance premiums for medical care not entered on line |
6
1
8
8

. Other medical and dental expenses (attach itemized list)
1. Total—(Add fines 4, 5 and 6)
. Enter 3% of adjusted gross income shown on Form 510 .
. Subtract line 8 from line 7, Enter difference (it les: sh than zero, enter zeta}
» 10, Total--(Add lines 1 and 9) .

Child Adoption Expense
11. Total expenses paid or incurred—Attach itemized fist

12. Enter 3% of adjusted gross income shown on Form 540 .
13. Subtract’ line 12 from fine 11—See instructions for maximum limitations .

Taxes ~

"14, Real estate .

15. State and local gasoline
18. General sales . : .
17. Auto license—Excess of registration 9 and weight tees (see instruction) an
18. Personal property . .

19. State disability insurance (SD) Employer private disability sla do not quatity
20. Other (specify) _ .

“21. Total taxes—(Add lines 14 through 20)

Contributions con oe, _
22. Cash—Includirig checks, money orders, ‘etc. (itemize)

23. Total. “cash “contributions.
- 24, Other than cash (see instructions). Enter total here on : ‘ : wo.
25. Total—Add lines 23 and 24—Maximum deduction may not exceed "20% at adjusted. Bross incre wo

(ntarast Expansa

28. Home ‘mortgage :
27, Installment purchases. a
28. Other (itemize) .

29. TotsltAdd lines 26, 27 and 28)

Mistollaneous Deductions

30. For child care, alimony, union dues, casualty losses, etc.—See instructions (itemize) nano ener een nce

MW Total miscellaneous. deductions: Ld 7

2. Total detuctions tng lines 10, 13, 21, 25,29 and 31). Enter total here and on form 440, paye 2: in spice provided” . S/o. EER

po Mey 1974)
W 86326 Docld: 32245535 Page 107

Schedule A on raverse

TAXABLE i

CALIFORNIA a.

TFORM,540 | ‘ . “PROFIT (GR LOSS) FROM BUSINESS OR PROFESSION = ; - - Sey
a (Sole Proprietorships) wo

SCHEDULE

9

Artoch this schedule.to your income tax raturn, Form 540 or 540NR — Portnerships, joint ventures, ete., must file on Form 345

Sssial Security Number

Name as shown on Form 540 or 540NR Y
322. 512. ! 7997

Samuel and Phyllis Ruby

wo. : - Foc s .
A. Principal business activity. FO08..* ervice ; product... .. a
. : : {For axample: “reteil— “hordware; wholesale— “tobacco; servicas — ~legal; manufacturing—fursiture; ete) a

“B. Business name... “Snack Rar Ce gente Soe ey ig ye Cc. Federal math identification number.” Doce,
DB, Business location... 5418 Van : woe ee . an IS Cal is Forny a _ 14601 Lesbbsnenitieseconeaten eeeneeee
. . (Number and street or ¢ rural route)” : “(City=post ‘office) 7 ce . Siete), so . tai code! .o

E. Indicate: method of accounting: - Cat cash; Oo accrual; [] other (describe) eomeneesnete
-f, Was theré any-substantial change in the manner of determining quantities, ‘costs ‘or ‘valuations between the opening and clasing

inventories? [1] Yes .[q No. If “yes,” attach explanation. ae re
G. Were Forms 591, 592, 596 and 599, for the calender year filed {if required)? (“Yes re No:

a Grois receipts or gross ‘sales $0. Le. Less: Returns ond allowances $ —
2. Inventory at beginning of year (Hf different than last year’s closing inventory at tach. . . vs
explanation)... Soe Soe foe Ce ke ef.) SCHEDULE’
Merchandise purchased $ . we a less cost of any items with. op Coe . ATTACHED
drawn from business for personal use $ : oa , rs on em,
Cost of labor (do not include salary paid to yourself)
. Material and supplies : ‘
Other costs (explain in Schedute C. 1).
Total of lines 2 through 6 ~
Inventory at end of this year. : : : .
Cost of goods sald and/or operations (subtract line 8 from line n.
. Gross profit (subtract line 9 from line 1) Lo ;
, . “OTRER BUSINESS | DEDUCTIONS |
, Depreciation (explain i in Schedule C-2) . .
Taxes on business and business property (explain in 1 Schedule C. 1)

Rent on business property

|. Repairs. (explain in Schedule C- 1). , .
- Salaries and wages not included on ‘Tine 4. (exclude | any: y paid to -yoursell)
« Insurance . . Soe

+ Legal and professional fees .

Commissions . . :
. Amortization (attach statement)

(a): Pension and profit-sharing plans (see instructions)

(b) Employee benefit programs (see instructions) woke

+ Interest on business indebtedness .° . ;

Bad debts arising from sales or services te -

Depletion of mines, oil. and gas wells, timber, ete. . (attach ‘schedule)

Other business expenses (explain in Schedule C-l) .

Total of lines 11 through 24 . . wo:
» Net profit (or loss) (subtract line 25 from line 10). ‘Enter here and on page 2 Form 540 < or S40NR

SCHEDULE an EXPLANATION OF LINES 6, 12, 14, AND 24

Explanation - : . [terre my wo 2 Explanation Ameunt «=

Rev, 1971)

W 88326 Docld:32245935 Page 108


Department of. the Treasury—Internal Revenue Service
Sk individual income Tax Return

wee ce ence geseceneesneesteseeenneee , 1973, ending

: vw) | COUNTY OF
pe ¥: d
Present home address ‘umber and ane po se bak namber, or + rural routs)
(6250 By & CHE Ke Re 7

RESIDENCE
City, town or Post oftica, State and ZIP code

Your social security number

322! 29992

Spouse's s social Sec: rity no

‘2-0

Ausere

4

: Filing creme only one:

. “Exemptions ° Regular / 65 or over / Blind oa,
1 Single : 6a Yourself... MM Cy Ester nN
2 A raried filing joint return (even if only one had income) b Spouse. . . FL - ian oO oF ennes > 2".
3 [] Married filing separately. If spouse is also filing give c First names,of your dependent children’ who lived with .

spouse’s social security number in designated space above

and enter full name here > __ Ek 1S = ERE number D>

4 [] Unmarried Head of Household d Number of other dependents (from line 27) . _
5 Cc Widow(er) with dependent child (Year spouse died > 19 )| 7 Total exemptions claimed . . . ._ op

. check [7] if spouse wishes to designate $1. Note: This will not increase your tax or reduce your refund. See note below.

(Attach Forms W~2. If
9 Wages, salaries, tips, and other employee compensation. unavailable, attach explanation) 9 ee _—_—

10a Dividends (see,ntucons)g OP Jonee 10b Less exclusion $°7. 4:
Aid (Gross amount received, if different from line 10a 211. Siete tects ccna ctee, )
11 Interest income . . . :
12 Income other than wages, dividends, and interest (from line © 38) .
"43 Total (add lines 9, 10c, 11, and 12)
14_' Adjustments to income (such as “sick pay,”” moving expenses, “ete. > from line 43) .
.15 Subtract line 14 from line 13 (adjusted gross income) . :

@ If you do not itemize deductions and line 15 is under $10,000, find tax in Tables and enter on line 16.
© if you. itemize deductions or line 15 is $10,000 or more, go to line 44 to figure tax.
©

Income = *

16 Tax, check if from:: Tax Tables 1-12 Tax Rate Schedule X, Y, or Z _ . ;

_ [Schedule D ] Rl Seats 6 Schedule G Yl Form 4726 form a726 lon|_]Fonm 972 Form 4972 } P| a6 109°
“17 Total credits (from line 54) _17_ a
18 Income tax (subtract line 17 from line 16) . se

‘19. Other taxes (from line 61) :

+ 20 Total (add lines 18 and 19)
ala Total Federal income tax withheld (attach Forms

W-2 or W-2P to front). . . . . . . | 21a
b 1973 estimated tax payments (include amount

- Please attach Copy B of Forms W-2 here |

Tax, omen and Credits

1972 return, but now wish to do so. If joint return, check Oi if spouse did not designate on 1972 return but now wishes to do so.

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, , and to the best of my knowledge and belief
“It is true, correct, and complete. Declaration of preparer (other than taxpayer) i is based on all information of which he has any knowledge. a

~ Write. soc.-see. no. on ‘Check or Money Order. Attach herel  -

{3717 VANGWEN. STREET
WAM NUYS, CA. 91403
~ 867-34-8729

A

8 Presidential Election Campaign Fund.—Check [_] if you wish to designate $1 of your taxes for this fund. if joint return, ;

CAUTION. If you have unearned income and can be claimed as a dependent on your parent's return, check here B> [] and see instructions on n page 7.

‘ allowed as credit from 1972 return) a __

c¢ Amount paid with Form 4868, Application for Automatic |

: Extension of Time to File U.S, Individual Income Tax Return c _

_-d Other payments (from line 1) d

22 Total (add | lines 2la, b, c, and d) Lo. ere
Ct) ; : Cee ot monee secer payable 7 . f : “ °
Bz 23° If line 20 is larger than line 22, enter BALANCE DUE IRS ‘to internal Revenue Service B> 23 | Y ae i ee
o = (Check here > Ol. if Form 2210, Form’ 2210F, or statement is attached. See instructions on page 8.) oe . — :
2 e 24 If line 22 is larger than line 20; enter amount OVERPAID. . ... . . . oa —_—:
3 ae 2 ‘ Amount of line 24 to.be REFUNDED TO YOU . , be .
fos) 26 Amount of line 24 to be credited on 1974 esti | 7
mated tax... woe “26

Note: i972 Presidential Election Campaign Fund Becignation, —Check | if you did not designate $1 of your taxes on your’,

Sign . —— _ ;
here P seg ——__$—$<$<—_—_$$——>— |. ss Prema eine Ge Ha Ea
: Your signature . : Date VY” Preparer’s signature (other than taxpayer) , ~ , |; Date
lye: . 7,
D Bb PBY-KI29
. Spouse's signature (if filing jointly, BOTH must sign even if only one had income). Address (and ZIP Gade) Papas Emp. Ident. or Soc. Sec. No. ©
.. . va .:16-—82337-2


‘

TAAL. | Adjustments to Income

a NW 88326 Docld:32245535 Page 110

= Total {add lines 28, 29,-30, 31,-32, 33, 34, 35, 36, and 37). Enter here and online 12 .

39 “Sick pay.’” (From Forms W-2 and W-2P, if not shown on Forms W-2 or W-2P, attach Form 2440 or statement.) _39 :
' 40 Moving expense (attach Form 3903) oo. . 40

41 Employee business expense (attach Form 2106 or statement) rn tee ee | AL

42 Payments as a self-employed person to a retirement plan, etc. (see Form 4848) : . | 420

43 Total adjustments (add lines 39, 40, 41, and 42). Enter here andon line 14... : . . B® 43

J
4 . a
* Form 1040 (1973) ~ ~". Page Z
3 b) ionship” Mi d) oD a A t YOU f) Amount fur-
| NAME tO) Relationship | rel bora or Wied | Sendent’ have | furnished Yor de: | hished by. OTHERS
= during year, write B or D. income Loft. pendent’ Ss sUuD- ingluding depen-
~5 aan " : $750 or more? port, ‘If 100% dent.
vo write ALL. .
£5 .
og 1% $
® | °
a - - -
27 Total number of dependents listed in columin (a). Enter here and on line 6d _. b>
PGE a Income other than Wages, Dividends, and Interest _
28 Business income or (loss) (attach Schedule C) Loe 28 *
29 Net-gain or (loss) from sale or exchange of capital assets (attach Schedule b) tone 29 : )
_30 Net gain or (loss) from Supplemental Schedule of Gains and Losses (attach Form 4797) . 30 {wey & 4 ,
31 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule Ew 31 :
’ 32 Farm income or (loss) (attach Schedule F) woe ee . _ 32
33 Fully taxable pensions and annuities (not reported on Schedule E—see instfuctions on page 8). 33}. +
34 50% of capital. gain distributions (not reported on Schedule D). ; 34
(¢ oes not.apply if refund tis for year in which you took 8). 35
35 State income tax refunds (standard deduction—others see instructions on page 8 —_—
36 Alimony received mo, _36_
' 37 Other (state nature and source) > 37

PTE. Tax Computation (Do not use this part if you use Tax Tables 1-12 to find your tax.)

44 Adjusted. gross income (from line 15) - oe
45 (a) If you itemize deductions, enter total from Schedule A, line 41 and attach Schedule A | .
(b) If you do not itemize deductions, enter 15% of line. 44, but do NOT enter more than .
$2,000. ($1,000 if'line 3 checked) J
46 Subtract line 45 from line 44 . tones
47 Multiply, total number of exemptions claimed on line 7, by $750 Boe

48 Taxable income. Subtract line 47 from line 46 . . .

“a5 5% wT

46 .
47 | BAP OQ |
CSA

376

(Figure your tax on ‘the amount on line 48 by using Tax Rate Schedule X, Y, or Z, or if
applicable, the alternative tax from Schedule D, income averaging from Schedule G, max-

imum tax from Form 4726, or special averaging ftom Form 4972.) Enter tax on line 16.

Ezmdne | Credits

49 Retirement income credit (attach Schedule R)
50 Investment credit (attach Form 3468)
51 Foreign tax credit (attach Form 1116)

53 Work Incentive (WIN) credit (attach Form 4874)

55 Self- ae tax (attach Schedule SE)

49

50 _

. . . . . 51 _

52 Credit for contributions to candidates for public office—see instructions onpage9. 52 __

an woe. | BBE

se Total credits (add lines 49, 50, 51, 52, and 53). Enter here andonlinely. . . . .m | 54, _
f.=\ Other Taxes oa : ;

_ ob. [88 2G

56 Tax from.recomputing prior-year investment credit (attach Form: 4255) _56_ __

57 Tax from recomputing prior-year Work Incentive (WIN) credit (attach schedule) : 57 _
58 Minimum tax. Check here Bb [], if Form 4625 is attached : _58 _
59 Social security tax on tip income not reported to employer (attach Form 4137).. 59 __
60

60 Uncollected employee social security tax on tips (from Forms’ W-2)
61 Total (add lines 55, 56, 57, 58, 59, and 60). Enter here and on line 19.

FGF -4| Other Payments

62 Excess FICA tax withheld (two or more employers—see instructions on page 9)
63 Credit for Federal tax on special fuels, nonhighway gasoline and lubricating oil (attach Form

4136). . .
64 Credit from a Regulated Investment Company (attach F Form 7 2439) . foe ees
65 Total (add lines 62, 63, and 64). Enter here and on line*21d woes >

e 2 | Did you, at any time during the taxable year, have’ any interest in or T signature © or other authority over

64
65

*

» 20S] a bank, securities, ‘or other financial account in a foreign country (except | ina US, military banking :
= 8 facility operated by a U.S. financial institution)? .. ° > Ep Yes. [] No
= =| if ‘Yes, " attach Form 4683. (For definitions, see Form 4683. ) NS
3k U.S. GOVERNMENT PRINTING OFFICE : 1973—-O- 500-047 16—89937-1

-* .

ane pected


ce . . : toner . fee fT Am gaMaEe ie

* °

‘, “ ae . -
'.SGHEDULE A . : . foe
"(Form 1040) Itemized Deductions 11 1973

4 +... Department of the Treastity : . > Attach to Form 1040.

Internal Revenue Service

shown on Form 1040

Name(s) Your social seountty number

Medical and | Dental Expenses (not compensated by insurance
or otherwise) for medicine and drugs, doctors, dentists, |
‘ nurses, hospital care, insurance premiums for medical care,

21 a Cash contributions for which you
have receipts, cancelled checks, etc. Sq’) .

etc.
. b Other cash contributions. List :
1 One half (but not more than $150) of ! . oo
insurance premiums for medical care. | / i 5 | donees and amounts. Dr..........-..-.- -|———————
(Be sure to include in line 10 below)

2 Medicine and drugs ;
- 3 Enter 1% of line 15, Form 1040

. 4 Subtract line 3 from line 2. Enter dif-
ference (if less than zero, enter zero) .

-5 Enter balance of insurance premiums |} y rad
for medical care not entered on line 1.

6 Enter other medical and dental expenses: 7 : :
a Doctors, dentists, etc... . 9. . 7.3 0
: . b Hospitals . . . , __ a |
° a c Other (itemize—-include ‘hearing aids, .
ae f 23 Carryover from prior years

dentures, eyeglasses, transportation, . .
. Yee p 6 oO ! 24 Total contributions (add lines 21a, b,
Teoeanonconmasacscommamannnc esc oe pevnces Pe | 22, and 23). Enter here and on line

: 33.0 > 150

eeeeeeen

22 Other ‘than cash (see instructions on
page 12 for required statement)

| |

i

— J 38.

| Casualty or Theft Loss(es) (See instructions on page 12.)
Note: /f you had more than one loss, omit lines 25 through
28 and see instructions on page 12 for guidance.

Loss before insurance reimbursement .

Insurance reimbursement.
Subtract liné 26 from line 25. Enter
difference (it less than zero, enter
zero) .

Enter $100 or amount on tine ‘27,
whichever is smaller. . . : \
Casualty or theft loss (subtract line 28 from :
line 27). Enter here and on line 39. & :
Miscellaneous Deductions (See instructions on page S12)

~
-

7 Total (add lines 4, 5, 6a, b, and ¢) toe het __|
8 Enter 3% of line 15, Form 1040. . . a |
9 Subtract line 8 from line 7 (if less than ; ‘
zero, enter zero) woe 769 _
10 Total (add lines 1 and 9). Enter here
andonline35 . . . . . 719.

rs... Taxes

30 Alimony paid

31 Union dues . woes

32 Expenses for child and dependent care
services (attach Form 2441)

| 33 Other (ltemize) Bee... ecceccceeeeenetees

11 State and local income

12 Real estate

13 State and local gasoline (see gas ss tax tables)
14 General sales (see sales tax tables)

15 Personal property . Son.
16 Other (itemize) Bonet eee te

34 Total (add lines 30, 31, 32, and 33).
Enterhereandonline40. . . . &

Vv Total (add lines 11, 12, 13, 14, 15, and 4 |
16). Enter here and on line 36 La , & _|| 35 Total medical and dental—line 10 .
Interest Expense : : | 36 Total taxes—line17. . . . .
37 Total interest—line 20. . . . . >) [4 g ‘|

} 38 Total contributions—line 24. . . . )Ss [2] _
'39 Casualty or thett loss(es)—line 29. . __

40 Total miscellaneous—line 34 :

41 Total deductions (add lines 35, 36, 37,

38, 39, and 40). Enter here and on SI aa

Form 1040, line 45... >

Wy U.S. GOVERNMENT PRINTING OFFICE : 1973—-0-500-049 , ” ye—b2349-3

Summary of Itemized Deductions

18 Home mortgage . Soe ete
19 Other (Itemize) B..........2.---.y eee

and on line 37.

» NW 88326 Docld:32245535 Page 111


i

é

7 SCHEDULE” ¢ | Profit or r (Loss) From & Business or Profession |
- Form 1040) | (Sole Proprietorship) : 197s

. Internal Revenue Service > Attach to Form 1040. ® Partnerships, joint ventures, etc., must file Form 1065.

2 AF a > product b........ = ~ ey,

er identificati
Bib. te

A Principal business activi

ngs Schedule © inctrugtions) &<
WS cK. BAR

B Business name >.......% £07. Seer Ee...
-D Business address (number and str
Oo City, State and ZIP code B......2.. a -

- we E Indicate method of accounting: (1) fac ‘Gash (2) [] Accrual (3) [7] Other B

F Were you required to file Form W-3 or Form 1096 for 1973? (See Schedule C Instructions.) .
_o., tf “Yes,” where filed _____. _ FR . E'S £fV¥.0 eee ne CF
. G Was an Employer's Quarterly Federal Tax Return, Form sis | for this business for any quarter in 1973?

H Method of inventory valuation £8. _ .-Was there any substantial change in
the manner of determining quantities, costs, or valuations ane the opening and closing inventories? (If. "Yes," attach explanation) . i-

1 Gross receipts or sales $. Less: returns and allowances $
‘2 Less: Cost of goods sold and/or operations (Schedule C~1, line 8)

3 Gross profit .

- 4 Other income. (attach schedule)

. 5 Total income (add lines 3 and 4)
’ 6 Depreciation (explain in Schedule C-3) .

7 Taxes on business and business property (explain in Schedule C2) .

8 Rent on business property

9 Repairs (explain in Schedule C-2) .

10 Salaries and wages not included on line 3, Schedule cel (exclude ¢ any ‘paid to yourself) .
11 insurance .

12, Legal and professional “fees .

13 Commissions
14 Amortization (attach statement)
15 (a) Pension and profit- sharing plans (see Schedule c instructions)

(b) Employee benefit programs (see Schedule C Instructions) .

16 Interest on business indebtedness .
17 Bad ‘debts arising from sales or services
18 Depletion . .
Other business expenses (specity):

Income 1

Deductions

(kK) Total other business expenses (add lines 19@) through 190)
20 Total deductions (add lines 6 through 19)

21 Net profit or (loss) (subtract line 20 from line 5). Enter here an
- enter on Schedule SE, line 5(a) ._.
SCHEDULE C-1.—Cost of Goods Sold ‘and/or Operations. Ses Schedule Cc Instructions for Line 2)

; 1 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation) .
tee.) D Purchases $......2--ee:eeeeeee- .... Less: cost of items withdrawn for personal use Qooceeceeceegeeeceeeeeeeeeeeeee. Balance >
‘. "3 Cost of labor (do not include salary paid to yourself) .
4 Materials and supplies .
5 Other costs (attach schedule)
6 Total of fines 1 through 5 .

7 Less:. Inventory at end of year . . : .
8 Cost. of goods sold and/or operations. Enter here and on line 2 above .

16—82344-1


r Page 2

SCHEDULE C-2.—Explanation of Lines 7 and 9

Line No. 7 Explanation Amount “Line No. 7 Explanation 7 Amount

‘SCHEDULE C—3.—Depreciation (See Schedule C Instructions for Line 6) If you need more space, you may use Form 4562.

Note: if depreciation is computed by using the Class Life (ADR) System for assets placed in service after December 31, 1970, or the Guideline
Class Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Life (ADR) System) or Form 5006
(Guideline Class Life System). Except as otherwise expressly provided in income tax regulations sections 1.167(a)—11(b)(5)(vi) and 1.167
(a)-12, the provisions of Revenue Procedures 62-21 and 65-13 are not applicable for taxable years ending after December 31, 1970.

Check box if you made an election this taxable year to use [7] Class Life (ADR) System and/or [—] Guideline Class Life System.

a. Group and guideline class b. Date c. Cost or . atte relation penal mel f. Life or g- Depreciation for
or description of property acquired other basis in prior years depreciation rate this year

“1 Total additional first-year depreciation (do not include in items
2 Depreciation from Form 4832 .+ see note \-
3 Depreciation from Form 5006 .* bove )
_. 4 Other depreciation:
"Buildings.
‘ Furniture. and fixtures
oe _. Transportation, equipment
Machinery and other equipment .
; Other (specify)

~ §& Totals 2. 2. 1 1 we we ee
*. 6 Less amount of depreciation claimed in Schedule C-1, pagel ©. 1 1 we ee : —|——
"+ 7 Balance—Enter here and on pagel, line6 . . . ww ee ee :
' ' SUMMARY. OF DEPRECIATION (Other Than Additional First-Year. Depreciation)

. i i ini . Sum of the: Units of : - j :
Straight line Declining balance years-digits production Other (specify) . Total

1 Depreciation from

Form 4832.0. foe see eecceee eee eene | -eeeeee ce eec eee cece eee | eee MAY V¥<_—~yfffvIQogf(ugcyuv, ------------~------ |=
_ 2 Depreciation from
Form 5! Sa nnn EE LLL CLL LL LLL LLL LLL PREY OE
3 Other - -:- aed
; _ . SCHEDULE C—4.—Expense Account Information (See Schedule C Instructions for Schedule C—4)
ae _ Enter information with regard to yourself and your five highest paid Name Expense account poalaries and Weaes _
. ‘7%. employees. In determining the five highest paid employees, expense | Qwner .-. . . . . YWWWTTIIWYT™

account allowances must be added to their salaries and wages. How-

“ever, the information need not be submitted for any employee for :
whom the combined amount is less than $10,000, or for yourself if
. your expense account allowance plus line 21, page 1, is less than :
$10,000... * evsepyeeees . : .

Did you claim a deduction for expenses connected with: 5 : :
i ¢)) Entertainment facility (boat, resort, ranch, etc.)?. . . (] Yes WY No (3) Employees’ families at conventions or meetings? . . . (] Yes i No
(2). Living accommodations (except employees on business)? [1] Yes No (4) Employee or family vacations not reported on Form W-2? (] Yes -[}f No

-Dowld:32245535; Page t13


ne

“SCHEDULE-D- | Capital Gains and Losses

(Form 1040) _ | » attach to Form 1040. p> Examples of property to be reported on this Schedule are 1973
“ "+ Department of the Treasury | | gains and losses on stocks, bonds, and similar investments, and gains (but not losses)

Internal Revenue Service on ‘personal assets such as a home or jewelry.
- Name(s) as shown on Form 1040

SAMUEL ‘Paty Ltt f hue a4.
N

~ PRA =] Short-term Capital Gains x Losses—Assets H

| Social security number
32-2! /2-' DFP P
ot More Than 6 Months ;

' : acaus red. c. Mo., day, yr. e Cost or other basis. .
. . Kind of property and description Enter letter (et date sold above d. Gross sales price _as adjusted “(see . f. Gain or (loss)
mo : “eamor, 100 shares of “‘2'' Co.) symbol (see acquired below a p instruction £) and (d less e)
: instiuction dotted Hine) expense of sale

rr Ld exgwatiowAr lec
‘op Levire

ton rer Isr
joo Esse lyre

Br) 8
_1/2@1 2797.
20h | BPS

: 2 Enter your share of net short- term gain or (loss), from partnerships and fiduciaries oko _27
, 3. Enter net gain or (loss), combine lines 1 and 2 “3
. 4(a) Short-term capital loss component carryover from years beginning before 1970 (see Instruction ) 4a)
ae 2) Short-term capital loss carryover attributable to years beginning after 1969 (see Instruction H) 4(b)

“a short-term gain or (loss), combine lines 3, 4(a) and 4(b) . 5

7 Capital gain distributions . re 7}
8 Enter gain, if applicable, from line 4(a)(1), Form 4797 (see instruction a). Se _8 _ —_
9 *. Enter your share of net long: -term gain or (loss) from partnerships and fiduciaries . . 9 :

_ 10 Enter your share of net long: -term gain from small business corporations (Subchapter S). . . _10_ _.

oa 12(b) Long- -term capital loss carryover attributable to’ years beginning after 1969 (see Instruction H) . . 12(b)
oo 13 Net long-term gain or (loss), combine lines 11, 12(a) and 12(b) . ww we 13

mo PERIL 4 Summary of Parts | and Il
a 14 Combine the amounts shown on lines 5 and 13, and enter the net gain orloss here. . . . “a UB OE3]_D
“ . . ~ a

15 If lirie-14 shows a gain—
: (a) Enter 50% of line 13 or 50% of line 14, whichever is smaller (see Part VI for r computation . .
of alternative tax). Enter zero if there is a loss or no entry on line 13.

4 : (b) Subtract line 15(a) from line 14. Enter here and on line 29,Form1040. . . . . . . 15(b) —_
. ~ 16 If line 14 shows a loss— .

B& Omit lines 16(a) and 16(b) and go to Part IV if losses are shown on BOTH lines 12(a) and 13.
ee See Instruction |.

” > Otherwise,

(a) Enter one of the following amounts: :

: ..- (i) lf amount on line 5 is zero or a net gain, enter 50% of amount on line 14;

a _ ++ .(ii) If amount on line 13 is zero or a net gain, enter amount on line 14; or,

oe Loy did lf amounts on line 5 and line 13 are net losses, enter amount on line 5 added to 6
os 50% of amount on line 13... . a 16(a)

(b) Enter here and enter as a (loss) on line 29, Form ‘1040, ‘the smallest of:
- (i) The amount on line 16(a);

di) $1,000 ($500 if married and filing a separate return—-if a loss is shown on line

4(a) or 12(a), see instruction M for a higher limit not to exceed 1 $1, 000); or, :

‘ (iii) Taxable income, as adjusted (see Instruction L) .. . » .. | 16(b)

per las? |Gba )
7

OR ad Net gain or (loss), combine lines 6 through 10 . . oy . ;
i 12(a) Long-term capital loss component carryover from years beginning before 1970 (see instruction Hy 12(a) Le ) ,


Tran a

Enter loss from line 5; if tine 5 is zero or a gain, enter a zero. 6 ee ee eh et
3 Enter loss from line 13... 1. . a
Enter gain, if any, from line 5; if line 5 is zero or a loss, enter a "zero :
Reduce loss on line 18 to the extent of the gain, if any, on line 19 .

Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero | 21 nen >
NOTE: If the entry on line 21 is zero, OMIT lines 22 through 28, and enteronfine29the; =)
an loss shown on line 12(a).
22 Enter gain, if any, from line 11 . Lo. 22
“ - 23 Enter smaller of amount on line 21 or line 22 rs a
‘4! 24 Enter excess of gain on line 21 over amount on linme23. 0. we eA -
f 25 Enter loss from line 4(a); if line 4(a) is blank, enter azero.. . a! _25 —_—
26 Reduce gain, if any, on line 24 to the extent of loss, if any, on ‘fine 25 (see | Instruction ). 26
27 Enter loss from tine 12(a) . ee is

_.."ux, 28 Add the gain(s) on line(s) 23 and 26 . .
vy 29 Reduce the loss on line 27 to the extent of the gain, i if any, on n line 28 3 (sea ‘Instruction K).

“30 Enter smaller of amount on line 29 or jine 20 (if tine 29 is‘zero, enterazero). 2. 6 ee ww

31 Subtract amount on line 30 from the loss online 20. 6 6 Ye ee et

32 Enter 50% ofthe amountonline 31. 0... eee ee eh

33 Add lines 17, 30, and 32. . . .

‘34 Enter here and enter as a (loss) on line ‘29, | Form 1040, ‘the , smallest of:

(a) Amount on line 33;

(b) $1,000 ($500 if married and filing a separate return—see Instruction M for a higher limit not to.exceed $1,000); or,

— Taxable Income, as adjusted (see Instruction L) . . . . .

Complete Part V if You are Married Filing a Separate Return and Losses are Sh

14. (See Instruction M).

own on. Lines A(a) and

oe 35 Combine lines 3 and 11 and if gain, enter gain; if zero or a loss, enter a zero . _35_
NOTE: If the entry on line 35 is zero, OMIT lines 36 through 42, and enter on line 43 the loss shown on tine hee).
;: 36 Enter gain, ‘if any, froomline3 . . . . a _36_
‘ 37 Enter smaller of amount on line 35 or line 36 . re er _37_
. 38° Enter excess of gain on line 35 over amount on line BF token vo. | 38 _
* 39 Enter joss from line 12(a); if line 12(a) is blank, enter a zero... see - _39_ - ;
a 40 Reduce the gain, if any, on line 38 to the extent of the loss, if any, on line 39 (see Instruction J). _40_ eas { ? i
"41 Enter loss from line 4(a) . . + a ’
42 Add the gain(s) on line(s) 37 and 40 toes 2. | 42
43 Reduce the loss on line 41 to the extent of the gain, if any, on n line 42 (see Instruction kK). woe 43 |. . oo

- ee] Computation of Alternative Tax (See Instruction V to See if the Alternative Tax Will Benefit You) -

., 44, Enter amount from fine 48, Form 1040 . 44
45 Enter amount from line 15(a) . . . Coc ee ee | 48
46 Subtract amount on line 45 from amount on 1 line 44 (but not less ‘than zero) . woe ee ee | AE at :
47 Enter smaller of amount on line 13 orline 14... . ee ee . | 47_

If line 47 does not exceed $50,000 ($25, 000 if married fling ‘separately), “check here > [] and
omit lines 48 through 54.
48 Enter long-term gains from certain contracts and installment sales referred to as “certain subsec-
tion (d) gains”! (see Instruction V) . . | 48.
49 Enter amount from line 48 or $50,000 ($25, 000 if married ‘filing separately), whichever i is larger . |_49
_50_

“ ~ -- If line 49 is equal to or greater than line 47, check here > Cl) and omit lines 50 through 54.
50 Multiply amount on line 49 by 50%

“+ SI Add amounts on'lines 46 and 50... . oy rr a2
52 Tax on line 44 or 45, whichever is greater (use Tax Rate Schedule in n instructions) . soe _ 52 |
‘ §3 Tax on the amount on line 51 (use Tax Rate Schedule in instructions) . _53_
Po 54 Subtract amount on line 53 from amount on line 52... ry _ 54
' ', 55 Tax on the- -amount on line 46 (use Tax Rate Schedule in instructions) . _55 |
' 86 If the block on line 47 or 49 is checked, enter 50% of line 45; otherwise enter 259; of line 49. 56 :
57 Alternative Tax—add amounts on lines 54 (if applicable), 55, and 56. If smaller than the tax figured
on the amount on line 48, Form 1040, enter this alternative tax on line 16, Form 1040 57

, . +& U.S, GOVERNMENT PRINTING OFFICE: 1973—-O-500-051 ; 16—82930-1

NW 88326 Docid:32245535 Page 115.


noe . ’

(Form 1040)

- | Department of the Treasury...
:-Internal Revenue Service

> See instructions on

wed ae ; a
» SCHEDULE G . income omen peet
p> Attach to Form 1040.

ges 3 and 4. | , | . 1973
. . Your social ‘security number
aise 2e7 7,

(a) - (b) . . {c)" - : (d) ° eC)

«.. Name(s) as shown on Form 1040

Taxable Income and Adjustments’

Computation year Ist preceding -base 2d preceding base 3d preceding base 4th preceding base
° Sot period year ~ period “year , period year period year ~*~
1973 1972 1971 . 1970 1969 -
1 Taxable income (see instruction D oo ? 6 6 Oa 0 . = ? aa O “

oS Bees om ene anne . LL _
~ tbe pny rr section 72) _

: 4 Accumulatioh distributions subject to sec-

A en | | a | TS |

5 Adjusted taxable income or base period

income. (Line 1 plus line 2, less lines 3 VS ~~
> and 4.) If less than zero, enter zero... 76 24 QO : om

: “Computation of Averagable Income

6 Adjusted taxable’ income from line 5, column (a)... ee ee ee 6 | 7@26—

2 : _ . _ 7 em oO emer,
| 7 30% of the sum of line 5, columns (b), (¢), (d), and (@)- 2 ee Pe
8 Averagable income (line6lessline7) . 9... 1 ee ee ee | 8 26 LG a
og . ‘Complete the remaining parts of this form only if line 8 is more than $3,000. If $3,000 or .
oe Be ; less, you do not qualify for income averaging. Do not fillin rest of form. L. 4

-_,'+ Computation of Tax

le

- 9 Amount from line 7. 6 eee ;
yo 20% oftne Se ee eto) ISDS ‘?
"4 Total (add lines 9 and 10) 2 ee ee | IS2-£ _

12 Amount from line 3, column (a), less any income subject to a penalty under section 72(m)(5)
'. which was: included-in line 3 : eo Cone ee wo ee ke

ISL
2/F : -

Y

| Ee Land

|. 43 Total (add lines 11 and 12) .
* 44 Tax on amount on fine 130. 6 eee ee ee ke
15 Tax on amount on line 120. we ee ee ee 15 Zz! f

—o—

\\G

:

“4° 16 Taxon amount on line 9 . a rs oe

“!. 497 Difference (line 15 less fine 16). . 2. 1 ee ee ee tal RIG We

18 Multiply the amount on line 17 by 4 . a &

19 Total (add lines 14 and 18). 6 0 ee ee

20 Tax on income subject to the penalty under section 72(m)(5) which was included in line 3 .- . 20 a

21 Tax (add lines 19 and 20). Enter here and on Form 1040, line 16. Also check Schedule G box on 10 rad
Form 1040, line 16.0. ee ee f ‘

. 16—82358-1

ser gyri tt ena meneame, somes tomcoeegg snare ermemeen gS OTE RITE


SCHEDULE’ SE “| Computation of Social Security Self-Employment
(Form 1040) p> Each self-employed person must file a Schedule SE. :

Department ofthe Treasury "| p> Attach to Form 1040.

If you had wages, including tips, of $10,800 or more that were subject to social security taxes, do not fill in this form. .
. @. If you had more than one business, combine profits and losses from all your businesses and farms on this Schedule SE.
Important.—The self-employment income reported below will be credited to your social security record and used in figuring social security benefits.

- ” NAME OF SELF-EMPLOYED PERSON {AS SHOWN_,ON SOCIAL SECURITY CARD) : Social security number
os 7 ff ; . of self-employed person
; A ; i 4

uE—lL # 2UILIFIP?

ay. 4-'@ if you have only farm income complete Parts | and Ill.
- * @ Ifyou have only nonfarm income complete Parts Il and Il.
met ©. If you have both farm and nonfarm income complete Parts |, Il, and Wh.

[AR | Computation of Net Earnings from FARM Self-Employment . i

A farmer may elect to compute net farm earnings using the OPTIONAL METHOD, line 3, instead of using the Regular Method,
line 2, if. his gross profits are: (1) $2,400 or less, or (2) more than $2,400 and net profits are less than $1,600. However, lines
1 and 2 must be completed even if you elect to use the FARM OPTIONAL METHOD.

1 REGULAR METHOD—Net profit or (loss) from: oo . WY Y
ae (a) Schedule F, line 54 (cash methoe, °r line 74 (accrual method). . = 6h.

yf

ff
‘ore,

a - (b) Farm partnerships. . 2-8 8 8 ef ee oF ht ts
gle 2 Net earnings. from farm self-employment (add lines 1(a) and 1(b)) . . ae ee
3 FARM OPTIONAL METHOD— If gross profits from farming are: a :

" @)y Not more than $2,400, enter two-thirds of the gross profits , . . viens -

.. (b) More than $2,400 and the het farm profit is less than $1,600, enter gi600. .... _— WY a
1 Gross profits from farming are the total gross profits from Schedule F, line 28 (cash method),
' or line 72 (accrual method), plus the distributive share of gross profits from farm partnerships

- ; (Schedule K~-1 (Form 1065), line 15) as explained in instructions for Schedule SE. YY, Yyy .

4 Enter here and on line 12(a), the amount on line 2, or line 3 if you elect the farm optional method .

Sparkie - Computation of Net Earnings from NONFARM Self-Employment

_ 5°. REGULAR METHOD—Net profit or (loss) from: .
: -_ _ (a) Schedule C, line 21. (Enter combined amount if more than one business.) . ; } 9 ¥,
_ (b) Partnerships, joint ventures, ete. (other than farming) , er
— 4 @ Servicé as a minister, member of a religious order, or a Christian Science practitioner. (Include
, rental value of parsonage or rental allowance furnished.) If. you filed Form 4361, check here [7]

~~ and enter zero on this line Loe ee

(a) Service with a foreign government or international organization rr

‘ (e) Other (director's fees, etc.). Specify Br... «nenaectecesesues Lecleseeanenecees pees esteseneeeceeenanen Pale
" °" 6 Total. (add-lines 5(a), 5(b), 5(c), 5(d), and 5(@)) 6 ee Loe

7 Enter other adjustments (attach statement) . Co nes bo ee

|

“8 Adjusted net earnings or (loss) from nonfarm self-employment (line 6, as adjusted by line7). . » 7 V8
~ If line 8 is $1,600 or more OR if you do not elect to use the Nonfarm Optional Method, omit lines 9 through 11 and enter

"_. amount from line 8 on line 12(b), Part 111. — ;
* Note:, You may use the nonfarm optional method (line 9 through line 11) only if line 8 is less than /)
. $1,600 and less than two-thirds of your gross nonfarm profits,” and you had actual net earn- Z
. .. ," ings from self-employment of $400 or more for at least 2 of the 3 following years: 1970, 1971, Y a
whe and 1972. The nonfarm optional method can only be used for 5 taxable years. /
“oe -* Gross profits from nonfarm business are the total of the gross profits from Schedule C, line 3, Y /

plus the distributive share of gross profits from nonfarm partnerships (Schedule K-1 (Form
1065), line 15) as explained in instructions for Schedule SE. Also, include gross profits from
‘services reported on lines 5(c), 5(d), and 5(e), as adjusted by line 7.

_ 9 NONFARM. OPTIONAL METHOD:

’* (a) Maximum amount reportable, under both optional methods combined (farm and nonfarm) . $1,600" 09

“ * (b) Enter.amount from line 3. (If you did not elect to use the farm optional method, enter zero.) . 2:
: es (c) Balance (subtract, line 9(b) from line 9(a)) . ‘ _
, 10 Enter two-thirds of gross nonfarm profits * or $1,600, whichever is smaller . rr —_—————_— —

-11 Enter here and on line 12(b), the amount on line 9(c) or line 10, whichever is smaller. .

‘


Schedule SE “(Form 1040) 1973 . a Page 2

Patt] Computation of Social Security Self-Employment Tax _

ct 12 Net earnings or (loss): :
ae (a) From farming (from line 4). 06 6 1 ee

; . (b) From nonfarm (from line 8, or line 11 if you elect to use the Nonfarm Optional Method) .
an . 43 Total net earnings or (loss) from self-employment reported on line 12. (If line 13 is less than $400,
you are not subject to self-employment tax. Do not fill in rest of form.) .
-. 14 The largest amount of combined wages and self-employment earnings sub-
; ject to social security tax for 1973 is .
Y
-15 (a) Total “‘FICA’’ wages as indicated on Forms W-2
(b) Unreported tips, if any, subject to FICA tax from
Form 4137, line 9 . .

_ (€) Total of lines 15(a) and 15(b) .

‘16 Balance (subtract line 15(c) from line 14).

17 Self-employment income—line 13 or 16, whichever is smaller .

18 If line 17 is $10,800, enter $864.00; if less, multiply the amount on line 17 by .08 . .
, ‘19 Railroad employee's and railroad employee representative's adjustment for hospital insurance bene-
ae fits tax from Form 4469 . :

20 Self-employment tax (subtract line 19 from line 18). Enter here and on Form 1040, fine 55.

You may use this space to make any needed computations

3x U.S. GOVERNMENT PRINTING OFFICE: W979—-0-500-055 ~ 16-—-82342-1


sg ET “TT

" AT9T- Supplemental Schedule of Gains and Losses
Form Sales, Exchanges and Involuntary Conversions under Sections 1231, 1245, 1250, etc. 1973
To be filed with Form 1040, 1041, 1065, 1120, etc.—See Instruction A :

Identifying number as shown on page 1
of your return Bg =

Department of the Treasury
Internal Revenue Service

Sales or Exchanges of Préperty Used in Trade or B dsiness and/or Involuntary Conversions
(Section 1231)

SECTION A.—Iinvoluntary Conversions Due to Casualty and Theft (See Instruction D)

‘ation al f. Gost or other basis, .
b. Date acquired | c. Date sold d. Gross, sales ee tee aitoorable) cost of subsaguient an u Sain oF {toss}
plus @ less

. 8, Kind of property (if necessary,
attach statement of descriptive
details not shown below) (mo., day, yr.) | (mo., day, yr.) price since acquisition chased, attach explana-

° tion) and expense of sale

2 Combine the amounts on line ‘L enter here and also on the appropriate line as follows .
(a) For all returns, except partnership returns:
(1) If line 2 is zero or a gain, enter such “amount in column g, line 3.
(2) Ifline 2 is a loss, enter the loss on line 5.
" (b) For partnership returns: Enter the amount shown on fine 2, on line 6, Schedule K (Form 1065).

__(b) For partnership returns: Enter the amount Shown oe ee
SECTION B.—Sales or Exchanges of Property Used in Trade or Business and Certain Involuntary Conversions (Not Reportable

-in Section A) (See Instruction D)

4 ‘Combine the amounts on line 3, enter here and also on the appropriate line as follows .
(a) For all returns, except partnership returns:
(1) If line 4 is a gain, enter such gain as a long- ‘term capital gain on the Schedule D (Form 1040, 1120, ete.), that is
, being filed—-see instruction D. "
(2) If line 4 is zero or a loss, enter such amount on line 6. : iP.
(b) For partnership returns: Enter the amount shown on line 4, on tine 7, Schedule K (Form 1065). 7 .

EB

Tac.) Ordinary Gains and Losses

f. Cost or other basis, le
cost of subsequent g. Gain or (loss)
improvements and (d plus e less f)

expense of sale

e. Depreciation al-
lowed (or allowable)
since acquisition

Kind of property and how acquired
it necessary,- attach statement of de-
scriptive details not shown below)

c. Date sold

b. Date acquired
(mo., day, yr.)

d, Gross sales
| (mo., day, yr.) i!

price .

5 Amount, ‘if. any, from: line 2(a)(2)
6 Amount, if any, from line 4(a)(2)
7 Gain, if any, from line 21 .

9 Combine: ‘tines 5 through 8, enter here and also on the appropriate line as follows .

(a) For all returns, except individual returns: Enter the gain or (loss) shown on line 9, on the line provided |
for on the return (Form 1120, etc.) being filed—see instruction E, for specific line reference.

(b) For individual returns:

‘

(1) If the gain or (loss) on line 9, includes losses which are to be treated as an itemized deduction on
Schedule A (Form 1040) (see instruction E), enter the total of such loss(es) here and include on
line 29, Schedule A (Form 1040)—-identify as loss from line '9(b)(1), Form 4797 .

(2). " Redetermine the gain or (loss) on line 9, excluding the loss (if any) entered on line 9(b)(1). Enter / 2248
..here and on line 30, Form 1040 . Loe, Coe ; ,

” 19—B2348-1


Pe oe BS NRT TO TT OEE TT

oe ¢

"Form 4797 (1973) ; ” BR Page 2
Gain From Disposition of Property Under Sections 1245, 1250,
: 1251, 1252——-Assets Held More than Six Months (See instruction F)

Lines 18 and 19 sould be omitted if there are no dispositions of farm ' property or farmland; or, if this form i is filed by a partnership.

. 10 Description of sections 1245, 1250, 1251, and 1252 property: . (ros acauired (me 4

Correlate lines 10(A) through 10(E) Property Property Property Property Property
(D) - (E)

with these columns > > P— P (A) (B) (Cc)

' 11 Gross sales price
12 Cost or other basis and expense o of s sale .
13 Depreciation allowed (or allowable) .
14 Adjusted basis, line 12 less line 13 .

oe 15 2—

15 Total gain, subtract line 14 from line i . (2-24 £ .
16 If section 12a6 prop erty: ble) it

(a) Depreciation allowed (or allowable) after
applicable date (see instructions) . . 12D & b ; _
, (b) Line 15 or line 16(a), whichever is smaller | 22. -Y & : Af . =
17 If section 1250 property: TOO Ss
(a) Enter additional depreciation after
12/31/63 and before 1/1/70 .

(b) Enter additional depreciation after ; . : . ; :
V2/30/69 ne Penn nenne cece eens nee ce eenne nce geennn ee) neceee enn e cee genceen | caeceecereneceeeeeeme| <ooceneenceeeeeeececes

(c) Enter line 15 or line 70), whichever i is
smaller . .

a

—

Line FO) times applicable percentage |
(see: ‘instruction F.4) .

-

—

Enter excess, if any, of line 15 over
line 17(b) . . wo.

(f) Enter. line 17(a) or line 17(e), wi whichever '
is smaller. . see ee ene ene en ence eens | pence mene ee enencccens | cence ce receencenneen:|seeeeemecenece rene cece | noeeceeeeeeeeneceeane

(g) Line 17(f) times applicable percentage , : . ¢
(see instruction’ F.4) . . :

(h) Add line 17(d) and line 17(2) soe
18 If section 1251 property:
(a) If farmland, enter soil, water, and Jand
clearing expenses for current year and ,
the four preceding years . . . seen emnenen nen nenennne | mnngennennecennnnn ener] onmenee a a

(b) if farm property, other than land, sub.
tract line 16(b) from line 15; OR, if farm-

~ Jand,:enter line 15 or line 18(a), which- .
ever is smaller (see instruction F.5) . |.------------neeenneee | enee cece eee ene ene ene| enn e eee e ence nees | amen gene n er een enced] cneeeeecnepeceneneres :

- (ce) Excess deductions account (see instruc-
tion F.5) _

(d) Enter-line 18(0) or line 18(c), wi whichever
is smaller .
19 If section 1252 property:
(a) Enter‘soil, water, and land clearing ex-

penses made after 12/31/69... | -----------------+-- ee wenn een nee nnn nen | anne nn eee ncn en pen eees| neeeneneneneseceeeeees
(b) Enter amount from line 18(0), if any; :
~ otherwise, enterazero. . seen neneeceeenn nnn nne | on lane ne enn nenn nnn nnnes| ncn enn nnn nnee ne nenne | ga gee ene nn een e eres | eeee ence pemeetercen
(c) Enter excess, if any, of line & 19(2) | over
line 19(b) .
_ (d) Line 19(c) times applicable percentage |
(see instruction F.5) . pence nee nee cence necen:| cen eeee een ec een en ne nes ae tae cee eneee nee gee cee |iee ences ee ce eeceee eee |enenee cn aeeeeceeree ce

(e) Line 15 less line 19(b) .
(f) Enter smaller of tine 19(d) or line 19(e)
_ Summary of Part Ill Gains (Complete Property columns (A) Through (E) up to line 19(f), before goi g to line 20)

20 Total of Property columns (A) through (E), line 15 . Lak

- 21 Total of Property columns (A) through (E), lines 16(b), 17(h), 18(d), and 19(f). Enter h here , anid’ on line 7. tS V2
22 Subtract line 21 from line 20. Enter here and in appropriate Section in Part | (see instructions D and F.2) . gO
$e US, GOVERNMENT PRINTING OFFICE :1973—-0-500-154 Og s2348-1


*

Department of the Treasury > Attach to Form 1040.
Internal Revenue Service

Form A798 . : aps a coe ao eal | 1978

Social Security Number

Ruby N32 JEP PP 7

A. Who Should File.—You will need to complete B. How to Compute Carryover.—lf you have a cap-
either Part | or Part Il of this form if you have a capital ital loss carryover, complete either Part | or Part II, but

- Joss to carryover to 1973. do not complete both.

You will have a capital loss carryover to 1973 if the A LOSS.

1. Complete only Part | if lines 4(a) and 12(a),
Schedule D (Form 1040) for 1972, DO NOT SHOW

-.. amount on line 16(a), or on line 33, of Schedule D 2. Complete only Part Il if either (or both) line 4(a)
- (Form 1040) for 1972 is LARGER THAN the loss de- or 12(a), Schedule D (Form 1040) for 1972,
ducted on line 36, Form 1040 for 1972. ‘ shows a loss. ,

.-3]. Post-1969 Capital Loss. Carryovers

Section A.—-Short-term Capital Loss Carryover

1 Enter loss from line 5, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
a gain, check this block [7], and QMIT lines 1 through 6 (because no short-term capital loss carry-
over exists) and enter the amount from line 36, Form 1040 for 1972 on line 7—then goto lineS .

2 Enter gain from tine 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
a loss, enter a zero .

3 Reduce loss, if any, on line 1 to extent of gain, if any, on line 2.
4 Enter amount from line 36, Form 1040 for 1972 .
"5 Enter smaller of amount on line 3 or line 4 .

6 Excess of amount on line 3 over amount on line 5.
beginning after 1969. Enter this amount on line 4(b), Schedule D (Form 1040) for 1973.

Section B.—Long-term Capital Loss Carryover

7 Line 4 less line 5 (unless you checked the block on line 1, and followed the tine 1 instruction) -

8 Enter loss from line 13, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
a gain, check this block (], and OMIT lines 8 through 12, because no long-term capital loss carry-
over existS.. 6 ee

9 Enter gain. from line 5, Schedule D (Form 1040) for 1972; however, if such line is blank or shows
a loss, enter a zero

10 Reduce loss on line 8 to extent of gain, if any, on line9 .

11 Multiply the amount on line. 7 by 2. . + - toe a bone

12 Excess of amount on line 10 over amountonlinell . . , .

Note: The amount on line 12 is your fong-term capital loss carryover from 1972 ta, 1973°that is attrib
after 1969. Enter this amount on line 12(b), Schedule D (Form 1040) tor 1923, x

nN

NW 88326 Docld:32245535 Page 121

eS

Note: The amount on line 6 is your short-term capital loss carryover from 1972 to 1973 that is attributable to years

7

10

11

12

AS

ie

a

utable to years beginning

3


zero). Enter here and on line 4(b), Schedule D (Form 1040) for 1973 .
21 If you ‘were required to complete Part IV, Schedule D (Form 1040) for
"1972, enter loss, if any, from line 30, Schedule D (Form 1040) for 1972.
Otherwise, enter zero
22 Enter excess of line 19 over line 18—if line ‘19 ‘does not exceed line 18,
enter zero (unless you checked the block on line 1, and followed the
line 1 instructions) 22 el lorD~
23 Loss carryover to 1973 (excess of line 21 over line 22—if line 21 does not exceed line 22, enter
zero). Enter here and on ‘line 12(a), Schedule D (Form .1040) for 1973 .
24 If you were required to complete Part IV, Schedule D (Form 1040) for
‘ 1972, enter loss, if any, from line 31, Schedule D (Form 1040) for 1972. :
Otherwise, enter Iss, if any, from line 13, Schedule D (Form 1040) for 1972 |_24_ l
25 Enter excess of line 22 over line 21 Be... -cseeecccceceeeeetees’ X 2 (if line
22 does not exceed line-21, enter zero.) .

26 Loss carryover to 1973 (excess of line 24 over line 25—if line 24 does not exceed line 25, enter
zero). Enter here and on line 12(b), Schedule D (Form 1040) for 1973 . soe

Yr U.S. GOVERNMENT PRINTING OFFICE : 1973—O-500-156 36-2603-697

21

2} 6 —

45535_Page.122_..

26 [tie

I cE TE teri terre carne a nied ~ ne ne 7
. . +
Form 4798 a Page 2
,,Pre-1970 and Post-1969 Capital Loss Carryovers
Section A.—Short-term “Capital Losses Identified -
1 Enter loss from line 5, Schedule D (Form 1040) for 1972; however, it such line is blank or shows
a gain, check this block JR], and OMIT lines 1 through 20 (because no short: term capital loss carry-
- over exists), complete line 41, enter loss from line 36, Form 1040 for 1972 on line 22—then go to
line 23 . 1
2 Enter gain from line 13, Schedule D (Form 1040) for 1972; however, if such line is : blank or “shows ‘
a loss enter a zero | . . 2
3 Reduce the loss on line 1 to the extent t of the gain, if any, on line 2 . 3.
Note: If line 4(a), Schedule D (Form 1040) for 1972 is blank, OMIT lines
‘4 through 11, enter a zero on line 12—then go to line 13.
4 Combine lines 3 and 11, Schedule D (Form 1040) for 1972 and if gain,
enter gain; if zero or a loss, enterazero. . . _4
Note: /f line 4 is zero, OMIT lines 5 through 11, enter on ‘line 12 the loss
from line 4(a), Schedule D (Form 1040) for 1972—then go to line
5 ‘Enter gain, if any, from line 3, Schedule D (Form 1040) for 1972 . _5_
6 Enter smaller of amount on line 4 or line 5 . a
7 Enter excess of gain on line 4 over amount on line6 . . ' 7
8 Enter loss from line 12), Schedule D (Form 1040) for 1972; otherwise,
enter a ‘zero _8
9 Reduce the gain, if any, on line 7 to the extent of the loss, if any, on line 8 9
10 Enter loss from line 4(a), Schedule D (Form 1040) for’ 1972; otherwise,
enterazero. . . ne re
11 Add the gain(s) on line(s) 6 and 9 . . ii
12 Reduce the loss on line 10 to the‘extent of the gain, i if any, on » line nl. 12
13 Pre:1970 short-term capital loss (enter smaller of amount on tine 3 or on line 12) . . . {13
14 Short-term capital loss attributable to years beginning after 1969 (excess of line 3 over line 13) . 14
Section B.—Computation of Capital Loss Carryovers to 1973
i?
15 Enter loss, if any, from line 13 above . 15 f
16. Enter loss deducted on line 36, Form 1040 for 1972... . |_16
17 Loss carryover to 1973 (excess of line 15 over line 16-—lf line 15 does not exceed line 16, enter
zero). Enter here and on line 4(a), Schedule D (Form 1040) for 1973 . _17_
18 Enter loss, if any, from line 14 above . . _18
19 Enter excess of tine 16 over line 15—if line 16 does not t exceed line 15, ;
enter zero . . 19
20 Loss carryover to 1973 (excess of line 18 0 over line 19—lf line 18 does not exceed line 19, enter
20


Rp or fee entre memcrnrrermnnns gan meen oe

vue 58 mueEL Z Payer Lo: huey

CALENDAR YEAR p73

ADDRESS Be w~hle ~ 2997 s0C, SEC, NO. __
. \ .
oe . DEDUCTION SCHEDULE
MEDICAL [FEDERAL] STATE [CONTRIBUTIONS | FEDERAL [P__ STATE
MEDIGING DRUGS PARTNERSHIP SHARE es
LESS 1% A.G.I. (Line 18 - 1040) | GiRL/BOY SCOUTS Li. [| {|
NET MED /DRUGS HEART FUND/CANCERFuND |} | |
1S. A INS. (4 + EXCESS) RED CROSS/UNITED FUND 7{ {| {|
DR. XMAS & EASTER SEALS | jso| jf
DR.  - Misc. ORGANIZED CHARITIES \ | | |
DR. po z CHURCHES ns ee ee ee
DR. an Se
DR. (
‘DR. yo
LDR. Af
| [otnertHancase S| SCT CT
PROSTHETIC APPLIANCES ToT ___| Pee torat contrieurions bY ESOT TAF a |
"HEARING AID [  [ [  [ [CASUALTY OR THEFT LOSS(ES) _
HOSPITAL [-| [ | [ross serore absustMENT es ee
AMBULANCE POTEET Fstcourationercasuattyy | TT
LABORATORIES : rhe —CSTCC |
TRAVEL FOR MED. / QOD. [fo ror cas. on tert toss pf
ff J WISCELLANEOUS DEDUCTIONS ee
MEDICARE INS. = [COT TT income Tax PREPARATION ee ee eee
GLASSES. LT |  uion/pRoFessionAaL DUES -—_ —}-}+--_
“MEDICAL EXPENSES | (265 | | /g.e| | unirorws/ProTec. CLOTHING TE
LESS REIMBURSED BY INS. rTP smatetoous ano suppues [TP
LESS 3% ADJ.GROSS INC. | Yoel | F797 PLAUNDRY AND CLEANING | | S|
[_ 747. | 2726] | Tauro usegoamace | TC:
+: (TO $150) OF H & AINS. | IspLt iF | [armonyiscneous, | |
10 TOTAL MEDICAL DED. rar PF LULL LAL | vest.counsecaruasyscuen) | | OP
TAXES _ [empLovment acencyrees | Ss | |
Sy REAL ESTATE EOTL LT | sareverosirsox |] CP
“STATE & LOCAL GASOLINE (ripe tT Prec reqineusmess |
GENERAL SALES TAX | Ate TP cnipaer. care (Fom aay) [|
STATE & LOCAL INCOME ee ee
‘PERSONAL PROPERTY "_ rT OCS CC(‘(SYP
/PERSONAL PROPERTY AUTO Se es
STATE DISABILITY INS.” ee YO) (KN (EO
_ SALES TAX AUTO ee :44 TOTAL MISC. DED. >| fT
: es ee eee _ Se ee
JL TOTAL TAXES TS OO Be ig DA a te EO
INTEREST (TO WHOM PAID) FSG, TOTAL TAXES (FROMLINE 17) | | of
MORTGAGE l2s760| [| S3ifoTa interest (Line 20) rT té<C~Ssté‘i*C
Oo | 2 [ | [38itotat contr. (Line 29 ee ee ee
a a EN NN KES TT
INSTALLMENT LOANS |
wets Verein | of [| [Remarks SS _
es Oe Ne
ee ee ee ”
20 TOTAL INTEREST. _- Db 3769.1 | 37671 1

"HAW 88376, Rosld22A5h35, Pagealddes, Calif. Form 101

ADDRESS

FROM BUSINESS OR PROFESSION

BUSINESS NAME

BUSINESS ADDRESS

TOTAL RECEIPTS

INVENTORY AT BEGINNING OF YEAR
MERCHANDISE PURCHASED

LABOR

TOTAL

INVENTORY AT END OF YEAR

GROSS PROFIT

“GROSS 1NCOME

“ADVERTISING
AUTO AND TRUCK EXPENSE
BAD DEBTS

CASH SHORT

, COMMISSIONS

ENTERTAINMENT AND PROMOTIONAL

DELIVERY

DEPRECIATION
. DUES AND SUBSCRIPTIONS

INSURANCE

~ INTEREST

JANITOR SERVICE

* LAUNDRY

LEGAL AND ACCOUNTING

MAINTENANCE

OFFICE SUPPLIES: AND EXPENSE

RENT

-

REPAIRS

SALARIES AND WAGES
SALARIES OFFICERS
‘SUPPLIES

TAXES AND LICENSES
TAXES + PAYROLL”

TELEPHONE

TRAVEL

UTILETIES

aw Fi F 7 1
yet pA i . i fP
a ae a ered —— o

¥

N

SCHEDULE OF PROFIT (OR LOSS )
PRINCIPAL BUSINESS ACTIVITY

{ SCHEDULE ATTACHED }

Les Ku BY

OR
soc. SEC, NO.

OTHER BUSINESS DEDUCTIONS

i

“NW:88

‘ PROFESS | ONAL STATIONERS INC,

LOS ANGELES,, CALIF.

FORM 104

326 Docld:32245535 Page 124

ET PROFIT:-OR( LOSS ) - FEDERAL RETURN

NET PROFIT OR Loss ) + STATE RETURN ( SEE DEPREC. SCHEDULE FOR DIFF. }

CALENDAR YEAR

19

EMPLOYERS NO.

|__|

i

| £OD
|

ws. ae
PI@Go | |

*

iy

:

ty
S

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, ~

SCHEDULE

19 ZF

FISCAL YEAR ENDING


KIND OF PROPERTY

roo PAs( ll

fo

Guth me WT

wae

OMPETE

Les

Hoel IMP.

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B
1

PROFESSIONAL STATIONERS INC. LOS ANGELES . CALIF.

CoVENENT N at tO

1.B. NO.

CALENDAR YEAR’ 19.
OR -
_ $0C. SEC, NO.

FISCAL YEAR ENDING

SCHEDULE OF

|
[
|

: Rg

DATE SPEC 20%

ACQUIRED
YR i

RATE(%)

OR LIFE - FOR
(yrs)

METHOD

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_ NW 88326 Docld

Add 20% non Items Purchased THIS Year.
Le 7 . TOTAL DEPRECIATION THIS YEAR | derorp |
FORM NO 102A 0 . : oo ; SCHEDULE - : i

OEPRECIATION

THIS YEAR

37245535 ' Page 125

7Z


INDIVIDUAL

CALIFORNIA

INCOME TAX
For the year January 1-December 31, 1973, or other taxable year beginning

Please vA Lb PHYS Rusby _ [B22 2 ' 2992

Type PRESENT HOME ADDRESS (Number apf street, including apartment number, or r Zal route) Spouse’s Social Security Number

or oP UY2®

me occu- | Yours iV /=s
/ f f ( f PATION ) spouse's Hi fue
fing Status Check ony “One : Exemption Credits If line 1 or 3 checked, enter $25
2.60 Single ts 6. Personal Exemption: | If line 2, 4 or 5 checked, enter $50
“2. S94 Married filing joint: return 7. Dependents - Do not list person who qualifies you as head of household.
3 Oo Married filing separate return—-Enter spouse’ s full Name (include last name and/or address if different from_ygur e ig hin
: AM genet * O10 PS oe. oR P
4: El: Head of Household—Enter name of qualifying ELISA ——
Mee) individual pene eneneenne
: =] - Widowler) with dependent child. Enter year spouse 8. Blind (refer to instiuctions) Number of blind exemptions
: ° died 19_ a “* 9. Total ‘exemption credits (add lines 6, 7 and 8) Enter here and on line 20 below.
7 ». Income Attach copy 2 of Form(s) We to front,

10. Wages, salaries, tips and other employee compensation \if unavailable, attach explanation
11. Dividends—before federal exclusion. Capital gain dividends must be included at 100%
12. Interest. (See instructions for taxability of federal, state and municipal bonds) .
13.. Income other than wages, dividends and interest (from line 50)

14. ‘Total add lines 10, 11, 12 and 13)

“Adjustments to income (from line 56) :

16. Adjusted gross income (subtract line 15 from line 14)

_
a

© if, you do NOT “itemize deductions AND line 16 is under 10,000, find tax in Tax Table and enter on line 19.
° If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.

17... Deductions: Itemized (from line 63) OR Standard ($1,000 if line” 1 or 3 checked—$2,000 if line 2, 4 or. 5 checked):
me 18 Taxable income (subtract line 17 from tine 16) Compute tax from Tax Rate Schedule—Enter tax on tine 19.

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bey
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en
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WV

:
i

19.. Tax—It an averaging method is used, check appropriate box O Schedule G, o ~~ .
20. Total exemption credits (from line 9, above) .
fs Cer 10 Tax - Jiability (subtract line 20 from line 19—if line 20 Ae breater than line 19, enter pa
Your - 99. Other credits (from line 66)... . Ce ae
: Tax 23. Net tax (subtract line 22 from line 21—if line 22 is greater ‘than ‘line 2 iter zero). soe : a
. Credits “ 24. Speciat tax credit—from line 75 (see Instructions, page 2, for. ae Suit)
.-« 25, ° Net:Tax liability (subtract line 24 from line 28—if line 24 is greater than Hitub3, enter zero)
26. Tax-on preference income (see instructions—attach Schedule POA)
a7: Total tax liability (add lines 25 and 26) . 2. 2. 1 we 2 ‘

>
2
s
=a

=

Renter's credit_if you lived in rented property on March L 1973, Zimplete Part | on page 2
Your . 29, Total ‘California income tax withheld (attach Form(s) W-2 or W2P to face of return).

~ AVVACH FORM DE1964 HERE
rity number: am cheek or ‘money ord; ATTACH HERE D>

te 30. 1973 California estimated tax payments (include amount allowable as a credit from 1972 return)
5. bredits 31. Excess California SD! tax withheld (attach Form*DE 1964 :to face of return) .
32. Total prepayment credits (add lines 28 through 31) :
. 33. If ‘ine 27 is equal to or larger ‘than line 32, enter amount of BALANCE DUE .. : .
‘Balance : Pay: in full and mail with return to: Franchise Tax Board, Sacramento, CA 95867 —_ “ be not write in these spaces
Due 34. If line 32 is larger than line 27, enter amount OVERPAID : re OR :
‘OF : Mail return to: Franchise Tax Board, P.0. Box "13-540, Sacramento, CA 95813 : Lk
Refund — 35.» Amount of line 34-to be REFUNDED. (allow at least ah weeks for your refund) . . . :
36.‘ Amount of line 34 to be credited on your 1974 stiles tax. sont eas ja} Mo

Under "penalties of perjury, 1 declare ‘that 1 have examined this veturn, ineluding accompanying schedules and statements, “and to the best of my knowledge and A?
belief it is true, correct and ‘complete. If prepared by a person other tl ae ayer, his declaration is based on all information of which he has any knowledge. F ooo

: ; . 13717 VANOWEN STREET
Ww. 88376 Docid: 32245535 Page 126 . - me - ; . 7 (MAN NUYS, CA. 91403

2 ABT B4RT Oe cine


sae oe nae

Page: 2 Form 549 (1973)

“PART i - Renter's Credit - All questions must be answered

emery

“ae ‘ v .
See Instructions, Page 2, for Allowable Credit

37. -Did you, on March I, 2973, live in rented property which was your principal residence? O Yes P&No lf no, you may not claim this credit

38. -Was the property you rented exempt from property. tax? . CO Yes OC No : If yes, you may not claim this credit

* 39: “Did you live with any other person who claimed you as a dependent for j income tax ‘purposes? . Yes 1 No If yes, you may not claim this credit
tf) Yes [] No If yes, see page 2 of instructions

40. Did you or your spouse claim the homeowners’ property tax exemption or receive public assistance? .

Other Income

PART Il -

’ Business income (or loss) (attach Schedule C(540)) .
.. Net gain (or. loss) from sale or exchange of capital assets (attach Schedule 01540)

42.
43. Net gain (or loss) from supplemental schedule of gains and losses (attach Schedule D- 1(540))
44, Pensions and annuities :
"45. Rents and royalties . Attach
. : Schedule E
46. Partnerships Form (540)
.4], Estates and trusts ©
_ 48. Farm income (or loss) (attach Schedule F(540))
(a) Fully taxable pensions and annuities (not reported 0 on Schedule “E(640)
49 Miscel -} (0) Alimiony . tak
"" jncome } (c) Other (state nature and a soneceeeceeoneganepeeeaneeeesonee

Enter total of lines 49(a), (b) and (c)
Total (add lines 41 through 49). Enter here and on line 13 .

’ PART Ill - Adjustments to Income

51. “Sick pay”, if included in line 10 (see instructions—attach statement)
"52. Moving expenses (see instructions—attach statement)
 §3. Employee business expenses (see instructions—attach satemet
54. Military exclusion (see instructions)
55....Payment as a’ self-employed person to a retirement pla, etc,
- §6. Total adjustments {add lines 51 through 55). Enter here and on line 15

PART IV - Itemized Deductions -

© Attach Schedule A(540) and enter sub-totals on lines 57 through 62, below

‘S37. “Total deductible medical and dental expenses (from Schedule A(540), line 10)
58. Total: child. adoption expenses (from Schedule A(540), line 13)
59. Total taxes (from Schedule A(540), line 21)
"60. Total interest expense (from Schedule A(540), line 25) :
"61." Total contributions. (from Schedule A(540), line 29)
. 62. Totals miscellaneous deductions (from Schedule A(540), line 40)

Total itemized deductions (add lines 57 through 62). Enter here and on line 7.

_ PART. ¥ - Other Credits - SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW

he 64. “Other State” net. income tax credit (attach copy of other. state return and Schedule $1540)
“65. rement income credit (attach Schedule R(540)) :

66. Total (add lines 64 ‘and 65). Enter here and om line 22

PART vl

. Special Tax cradi

G7. Taxable income from fine 18 (or line 16 if Tax Table used)

~ 68. Amount of gain or loss {if any) entered on Schedule D(540), line 14 .

_ 69., Amount of gain or loss (if any) entered on Schedule D(540), tine 15
70. :, Combine lines 68 and 69 and enter total here. If zero or a loss, enter zero
71." Adjusted taxable income (subtract line 70 from line 67)

- 72, Adjusted tax (use same methed as used for determining tax on line 19)
"73. Add lines 20 and’ 22, and enter total here

‘Adjusted net tax (subtract line 73 from line 72)
. Special tax credit—Determine allowable credit using Table on page 2 of i instructions.

ON SEPARATE RETURNS OF MARRIED TAXPAYERS, BOTH MUST ITEMIZE
DEDUCTIONS OR BOTH MUST TAKE THE STANDARD DEDUCTION.

"Enter here and

49

If you report net gains from capital assets held more than one year on Schedule D(540), complete all lines below.
All other taxpayers enter ‘Net Tax” from line 23 on line 74 and complete line 75. :

on line 24

13714-4090 5-73 10,000M © A ose


ITEMIZED DEDUCTIONS -

Attach to Form 540

the standard deduction. If you. choose to itemize your deductions, complete the
appropriate items below.

methods. You can either itemize your deductions or take a standard deduction as
explained in the 540 Instructions. On separate returns of a husband and wife,

Itemized ¥S. Standard Beduction—You have a choice between two deduction | if one spouse itemizes deductions, the other may not use the Tax ‘Table or claim

Medical. and dental expenses (not compensated by insurance or otherwise) for
c, medicine and-drugs, doctors, dentists, nurses, hospi- : :
vitae ot . tal care, insurance premiums for medical care, etc. 22. Home mortgage .

ne , cane —— 23. Installment purchases

1. One half (but not more than $150) of insurance oo po st
“premiums for medical. cares. / 5 oO " 24. Other (itemize). 2 6 we ey

. 2. Medicine and drugs. ee Lee eeeeeeeetee dienes.

Interest Expense

“13, Enter 1% of af adjusted gross income shown 0 on Form

540.
4. “Subtract line 3 from ‘line 2. Enter difference (if line. :
3. is Breater "than line 2, ‘enter zero) . . : 25." Total—(Add lines 22, 23, and ‘2 Enter ‘here and ;

| ee in on Form 540,-page 2)
5. Enter ‘balance of insurance premiums for medical ° U yay
care not entered on line 1 . . . :

Contributions

6. Other medical and dental expenses; a [ ; oO 26. Cash contributions for which h , en ay

uy . : . . Cash contributions for whic! you ave rect, can- ;
(a) Doctors, dentists, etc... Lone 73 7) wpe celed checks, atc, 7, } sO | _
{b) Hospitals . 7

Other cash contributions, List donees and amounts - Ne ceeecceeereneee Jones

*Total—iadd lines 4, 5, 6a, b, ade)... , LA ee S|

. Enter 3% of adjusted ross income shown on : : ; . co
".. Form 540. . woes ; ;
‘ 28. Other than cash. — See instructions for required :

4. Subtract line 8 from-line 7. Enter difference (if 966 statement 2 2 woes —_—. ;
7 “ti i i » . . ‘ . - ot 5
"7, fine 8 is greater than fine 7, enter zero} == 1 — | 25, totai—iadd lines 26, 27 and 28. Maximum deduction 7
40. Total—Add- lines 1 and 9, Enter here and on 9 /¢ may not exceed 20% of adjusted gross income. : wey 0
“Form 540, page 2)... ; iP f Enter here and on Form 540, page 2)...
child Adoption Expense ~ ; . : Miscellaneous Detluctions
Casualty or Theft Loss(es)—See tnstructions . -
Wt Total expenses. aid or incurred—Attach itemized . NOTE: If you had more than one loss, omit fines 30 .
list : : So Lleeeceeeegereeepeee ‘| through 34 and follow instructions for guidance. 5 ;
12. Enter 3% of adjusted gross income shown on \ Form . 30: Loss before insurance reimbursement... ©. | oluteeteeeeeeeee fone
‘n 540 . FE enn 31. Insurance reimbursement . :
: 13. Subtract fine 12 from line 11—See instructions . 32. Subtract line 31 from tine 30. Enter difference ‘it
for maximum limitations. (enter here and on Form ~——f} <r line 31 is greater than line 30, enter zero)
540, page 2) chs on . Ad 33. Enter $100 or amount on line 32, whichever is 7
' : smaller .
“Taxes (See tables on reverse) : 34, Casualty or theft loss (ine 2 | less 5 line 33)-
“14, Realestate 2 0 0 Leeder: 35. Alimony paid ~
, 15. State ‘and local gasoline ee 36. Child care—See instructions
16. General sales ‘ a * 37. Union dues on
38. Employment educati —
17. Auto license—Excess of registration @ and weight f fees ployment education expense se instructions os eneeeenenneenes Genel
(see instructions) _ 39. Other—See instructions itemize). © 6 6. ee eee eben
18. Personal property Loe ae ;
19. “State disability insurance (SDI) Employer. private

disability plans do not qualify
20. Other

| 21. Total ‘tares—iAdd tines 4 tough 20. Enter here
and on Form 540, page 2) Nod

40. Total—Add lines 34, 35, 36, 37, 38 and 39. (Enter
"here and on Form 540, page 2) . . ,

- (Rev. 1973)
_ NW Baste Docld: 32245535 Page 128

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships) ”

-* Amach this schedulo te your Income tax em Form 540 or SCONR — Partnerships, joint. yontures, ete., must filo om Form 363

: A | Princigal business activity... “Say a = i B & = ene ceseceneneepeeeeeeeeee j tla Aas ceneeeeeeee 7

: (See Instructions for “Item A.”) “(For example: retail-hardware; wholesale—tobacco; services—legal; monufacturing—furniture; etc.)

. B. Business name_.. SNA. LE. AR... coh ee cone eee C. Federal employer ry, ification number.........-.cg¢-------20-eeeceece
.. Business address. .... a. Y1é | CWA Vays Bev ke lf. Uo.- van ¥ Le A. Days vee CA ELE...

~ “(ZIP code) ~

E. Indicate method of accounting: cash; [[] accrual; [J other.
“Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? PRL Yes (] No !
G. Method of inventory valuation B.__............-- COST ae nent ceccececchensaeegeeees

*. Was there any substantial change in the manner of determining quantities, costs, or valuations between the apening and closing inventories?
“DYES: [J NO.. Jf “Yes,” attach explanation.

- IMPORTANT—All opplicable lines and schedules must be filled in.

1 Gross receipts or sales $_____________ Less returns and allowances $2, Balance > paren .

2 Less: Cost of goods sold (Schedule C-1, line 29) and/or operations (attach schedule) . Loe ee,

3 Gross profit . a

4 Other income (attach scheduie)

5 TOTAL income (add lines 3 and 4)

& Depreciation (explain in Schedule C- 3)

"J Taxes on business and business property (expla | ths Schedule C. 2)

& Rent ‘on business property :

| 9 Repairs (explain in Schedule C-2) . .

‘JI Salaries and. wages not included on line 24, Schedule c 1 (exclude o any ‘paid t to yourself) .

:[11 Insurance : sone

12 Legal and professional fees

13 Commissions ..

14 Amortization ‘(attach statement)

15 (a) Pension and profit-sharifig:
(b) Employee benefit progi

|1G Interest on business indebiSdr .

17 Bad debts arising from sales or - services

18 Depletion

19 Other business expenses (specify): |

=
9
y
8

My

my a

(see Instructions for line 15(a)) .
tructions for line 15(b))

DEDUCTIONS

. (@)
(h) Total other business expenses (add lines 19(a) through Wg). 2. 2 ee ee
20 Total deductions (add lines 6through 19). 2... tee ee OO Cp Re Per

21, Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form S40NR

“SCHEDULE C-1. CcOsY OF GOODS SOLD (See Schedule € Instructions for line 2)

* 29 inventory at beginning of year (if different, from last year’s closing inventory, attach explanation)

_ 23 Purchases $.... Less cost of itémhs withdrawn for personal use $200 ee Balance >
24 Cost of labor (do not include salary paid to yourself) ,

25. Materials and supplies

26 Other costs (attach schedule) cee

27 Total of lines 22 through 26 2 © 6 ms

i 2B Less: Inventory at end of year .
| 29 Cost of ee sold. Enter here and on line 2, ‘above

1232245535 Page 129


ort a en ae al
chedule C (Forin 540) (Rev. 1973) . Page 2

“SCHEDULE C-2. Explanation of Lines 7 and 9

Explanation mo Amount

SCHEDULE C-3. DEPRECIATION (See Schedule C Instructions for line 6). NOTE: Depreciation may be computed by
_using the Asset Guideline Classes specified in Federal Revenue Procedure 72-10, regardless of when assets were

. placed in service. If this methed is used, do NOT use the Lower Limit or the Upper Limit (ADR) Ranges. Attach
- detailed statement of depreciation computation.

tao

mu, a. Group and guideline class b. Date ¢. Cost or d. Depreciation e. Method of f, Lifeor |g. Depreciation for
; or description of property acquired other basis a OWE ree come rate this year

» 1 Total additional first-year depreciation (do not include in items below) >

® Asset Guideline Class System ‘(See Note above)
3 Other depreciation
Buildings ae
Furniture and fixtures .
, Transportation equipment .
‘ Machinery and other equipment .
" Other (specify)

4 .
.5 Less: Amount of depreciation claimed ‘elsewhere i in n Schedule Clos
& Boalance—Enter here and on page 1, line 6 .

Summary Straight fine ‘Declining balance aah ae Other (specify) . Totat

7 Line 2, above

& Other. . ZOOM mi: =——s

SCHEDULE C-4. Expense Account Information (See Schedule C Instructions for Schedule C-4)

Expense Account Salaries and Wages

. Enter information with regard to yourself and your five
highest paid employees. In determining the five highest
. paid employees, expense account allowances must be
added to their salaries and wages. However, the infor-
mation ‘need not be. submitted for any employee for - wees
whom the combined amount is less than $10,000, or - nn ene

’ for yourself if your expense account allowance plus
line 21, page 1 is less than $10,000.

” Did you claim a deduction for expenses connected with:

‘ (1) Entertainment facility (boat, resort, ranch, etc.)? (3) Employees’ families at conventions or meetings?
CO Yes No (] Yes No

_ 2) living accommodations (except employees on business)? (4) Employee or family vacations not reported on Form W-2?
] Yes - No Yes No

NW 88326, Docid:32245535 Page 130 00 - _ mo ar19-400 #273 2,000 @ A ose

mn

CALIFORNIA

CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

Use this schedule to report gains and losses on stocks, bonds and similar investments,
and gains (but not losses) on personal assets such as a home or jewelry.

2. Enter gain (or loss), if applicable, from line 18, Sched ule D 1 (540) “(attach | copy)
3. Enter your share of net gain or loss from partnerships and fiduciaries .
4, Net gain or loss, combine lines 1, 2 and 3 =

PART il—Assets Held More Than One Year But Not More Than Five Years

‘6. Enter gain (or loss), if applicable, from ling 20, Schedule D-1 (540) ‘aivach copy) |

JF,
8.

adjusted, cost of subse-

a. Kind of property and description b. Date acquired c. Date sold d. Gross sales quent improvements (if
(Example, 100 shares of ‘‘Z’ Co.) (mo., day, yr.) (mo., day, yr.) price not purchased, attach
a ue explanation) and ex-

pense of sale

e. Cost or other basis as

f. Gain or loss
(d. Jess €.)

Enter your share of net gain or loss from partnerships and fiduciaries
Net gain or loss, combine lines 5, 6 and 7

“PART Ill—Assets Held More Than Five Years

10.
1.

12.

Enter gain (or loss), if applicable, from line 22, Schedule D-1 (540) (attach * copy)
Enter your share of gain or loss from partnerships and fiduciaries
Net gain or loss, combine lines 9, TO and 11

PART {¥—Summary of Capital Gains and Losses
13. oe
14."
15.

16.
7.

18,

19.

‘* (a) amount on line 17;

* .*(b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange

~(c) $1,000 ($500. in the case of a husband or wife filing a separate return).
“nw 88326. Docid:32245535 Page ii. . .

Enter amount from line 4

Enter 65% of the amount on line 8 .

Enter 50% of the amount on line 12 197e tos-3- py Baz. - 4

Enter unused capital loss carryover from preceding taxable years (attach foe
Combine the amounts shown on lines 13, 14, 15 and 16 .

If line 17 shows a gain, enter here and on page 2, Part If of Form 540 « or 540NR .
If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR the smallest of.

of capital assets; or

Screeners agree ecespstnnee nga presen enenepecnttnennensite seen te

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES

(Sales or Exchanges including tnvoluntary Conversions)
(Attach to Form 540, 540NR, 541 or 565)

PART 1° Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220

‘ Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.
“1... Description of Sections 18211, 18212- 18, 18219, and 18220 property. ’ (me aan ye.)
f i _¥/ 20. | BBs 22

Correlate lines 1(A) through 1(D) with these columns a << Pow Property Property

Gross sales price .
Cost or other basis and expense of sale
Depreciation allowed (or allowable) .
Adjusted basis, line 3 less line 4
Total gain, subtract line 5 from line 2
1f Section 18211 property: .
, (a) Depreciation allowed (or allowable) after applicable date.
(See- Instruction D-3) woe
. (b) Line 6 or line 7(a), whichever is smaller
8. If Section 18212-18 property:
- (a). Enter additional depreciation after 12-31-63 and before
1-1-71 . Lo
. (b) Enter additional depreciation after 12- 31-70 .
’ (c) Enter line 6 or line 8(b), whichever is smaller .
(d) Line 8(c) times applicable percentage (Instruction D-4) :
» (e) Enter excess, if any, of line 6 over line 8(b)
(f) Enter fine 8(a) or line 8(e), whichever is smaller .
_'(g) Line 8(f) times applicable percentage (nstruction D. 4) .
(h) Add line 8(d) and line 8(g) | . woe
'.. 9 Hf Section 18220 property:
.. (a) If farm land, enter soil and water conservation expenses
for current year and four preceding years . .
(b) If farm property, other than land, subtract line 7(b) from
line 6; OR, if farm land, enter line 6 or line 9{a), which-
_ ever is smaller (see Instruction D-5)
» (ec) Excess deductions account (see Instruction D-5)
- (d) Enter line. 9(b) or line 9(c), whichever is smaller .
10. If Section 18219 property:
(a) Soil and water conservation expenses made after 12-31-69
(b) Enter amount from line 9(d), if any; otherwise, enter a zero
(c) Enter excess, if any, of line 10(a) over 10(b)
(d) Line 10(c) times applicable percentage (Instruction D-5)
* (e) Line 6 less line 10(b) .
’. (f) Enter smailer of line 10(d) or line 10(e) .
SUMMARY OF PART | (Complete Property Columns A) through (D) up to Line 10(f) before going to Line 11).
_ 11. Enter amounts.from line 6 .
| 12. Enter amounts from lines 7(b), 8h), 9(d) ‘and 10(4)
- 13. Subtract line 12 from line 11, enter here and in appropriate
_Section in Part Il (see Instruction D-2) . 2.
. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part tl oo. 122.4 & —_

N[o oe Od

. (REV. 1973)

WW 88326 Docld: 32245535 Page 132 _


aS - eae a a . - we et map re ee
7 a : . ss :

“Schedule D-1(840) ¢ va Page 2

PART Bf Sales or Exchanges of Property Used in Trade or Business and/or Involuntary Conversions
(Section 18181-82) see Instruction E

’ Section A— INVOLUNTARY CONVERSIONS DUE TO CASUALTY AND THEFT

f. Cost or other basis, cost of
subsequent improvements
- (if not purchased,
attach explanation) and
expense of sale

8 Depreciation allowed
{or allowable) .
since acquisition

9. Gain (or loss)
(d. plus e. tess f.)

a. Kind of property (if necessary,
attach statement of descriptive
details not shown betow)

c. Date sold

bh. Date acquired '
(mo., day,- Wt )

(mo., day, yr.)

d. Gross sales
price

16. Combine the amounts on line 15, enter here and also on the appropriate line as “follows
_ (a) For all returns, except partnership returns: (1) If line 16 is zero or a gain, enter amount of each” gain or ‘oss, above, in
; - column (g) of applicable Section: B-1, B-2 or B-3; (2) ‘If line 16 is a loss, enter such amount on line 25 of Part It.
' (b) For partnership returns: Enter gain(s) and loss(es) in Schedule K (Form 565). See Instruction E.
' Section B— SALES OR EXCHANGES OF PROPERTY USED IN TRADE OR BUSINESS: AND CERTAIN INVOLUNTARY CONVERSIONS
(Not Ht Reportable in Section A) .

5 "Section 8-1 Property Held One Year or Less

ai mm ocr he ene A IR eee me

* Section B-3 Property Held More Than Five- Years

22. Combine the amounts on line 21, enter here . .
23. Combine the amounts on lines 18, 20 and 22; enter here and also on the ‘appropriate ling as follows

(a) For all returns, except partnership returns: (1) If tine 23 is a “gain, enter the amounts from lines 18, 20 and 22, on lines 2, 6
and 10, respectively, of the Schedule D (Form 540 or 541) that is being filed. (2) if line 23 is a loss, enter such | amount on
line 26 of Part Hil.

” (b) For partnership returns: Enter amounts on fines 18, 20° and 22, in Schedule K(565)—see Instruction E. .
PART Ii Ordinary Gains and Losses : so

<

a. Kind of property and how
acquired (if necessary,
attach statement of descriptive
details not shown below)

f. Cost or other basis, cost of
subsequent improvements
and expensé of sale

e. Depreciation allowed
(or allowable)
since acquisition

g. ‘Gain (or loss)

d. Gross sales
neue (d. plus e. less f.)

+ price

c. Date sold

b, Date acquired
(mo., day, yr.)

(mo., day, yr.)

4. Gain, if any, from line 14
25. Loss, if any,.from line 16
. Loss, if any, from line 23

28. Combine lines-24 through 27, enter here and also on the appropriate line as follows
(a) For fiduciary and partnership returns: Enter the gain (or loss) shown on line 28 on the line provided for on the
return being filed—see Instruction F for specific line reference.
(b) For individual returns:
(1) If the gain (or loss) on line 28 includes losses which are to be treated as an itemized deduction on
Schedule A (Form 540 or 540NR) (see Instruction F), enter the total of such loss(es) here and on

Schedule A (Form 540 or 540NR)—Identify as loss from line 28(b)(1), Schedule D-1 (Form540).

(2) Redetermine the gain (or loss)-on line 28, excluding the loss (if any) entered on line 2B(6)(1). Enter here
7 and on page 2 of Form 540 or Form 540NR, under “Other Income” toe, ae Lee re 48


For the year January 1-December 31, 1970, or othor taxable year beginning

- US

Department of the Treasury /
individual income Tax Return

Internal Revenue Service

, 1970, ending -__.

r
cF g Firat name end initial (If Joint return, use first names ond middle initials of both) Last name
~2  - SAMUEL AND PHYLLIS 2. RUBY 3221, 14 7997
2 “Present home address (Number and street or rural route) Spouse's soclal security number
B 16250 Bircher ee . 349: 148 1420
o . @ City, town or post office, State and ZIP code : ' occu. Yours Se@ lf- -Empe
« a ;
* & Granada Hills, California sd Panto | Suse's Housewife
. Filing Status—check only one: Exemptions Regular / 65 or over / Blind enter
* “1 Single; 2 20 Married filing jointly (Ra j%ouy one 7 Yourself . .. Ki 0 C] BP eokes|
* 3 (J Married filing separately and spouse is also filing. 8B Spouse (2>Plies anly tf item Kj ] (7 shecked 2 _
yey x. “s pace ahve ardent spouse's social security number in | 9 First names of your dependent children who lived with |
> B| firstname here _ you Pred, Brians Elisa, eae 4
2 4 ( Unmarried Head of Household nn ‘Thomas _ _ number >|
VI, 5a Surviving widow(er) with dependent chiid 10 Number of other dependents (from line 34). >,

: | _6 [i Married filing separately and spouse is not filing |_11, Total exemptions claimed — >| 6
£ 12 Wages, salaries, tips, etc. (Attach Forms W~2 to back..If unavailable, attach explanation) . | d2- a
3S :
fs) ; .

2 13a Dividends (,*2°°* 3.) $.. 20-60 13b Less exclusion g 20. 60. Balance . pe _13¢ -

ha 8 ® * {Also list in Part | of Schedule B, if gross dividends and other distributions are over $100)
; E E 14 Interest. Enter total here (also list in Part Il of Schedule B, if total is over $100). . . _24 |
4 fo)
3
Ly c + +
9; ™ 15 income other than wages, dividends, and interest (from line 40) . ~ 15 2 1284 22
: a 16 Total (add lines 12,4 16) 7,284 97
17 Adjustments to '' moving expense, etc. from line 45) 7 -
‘ 1.18 Adjusted gross incti ) ae : 18 7,284 97
@ See page nage 2 of instructions for rules Gr tax and surcharge. 7 7
@ ‘If you do not itemize deductions and liné in Tables. Enter tax on line 19.
@ Ifyou itemize deductions or line 18 is $10,0 tax.
oe Py Pedule D(C], or Schedule G [}) |-22. |... 11? | 53

_ 2 a gu claim retire!

¥ co é

o © Se }-

é we OP le. _

(7 re ty
At 2¥ ‘Total (add lines 19 and 20) . _____ 117/53
~ a ot
e |. , a
3 oy 22 Total credits (from line 55)... A
: 5 Ki 23 Income tax (subtract line 22 from line 21) . :
§ BZ | 24 Other taxes (from line 61) 2. 1. a 24° 338. 20
©
s| 2 ;
= e 25 Total (add lines 23.and 24). Lo made
‘ Lp ee
3 £ |°26 Total Federai income tax withheld (attach Forms w-2 to back) . | 26 | . VE check or money Z
. 2 & 27 1970 Estimated tax payments (include 1969 overpayment allowed as a credit) | 27 | : | _ Zoster payable f inter. Y)
8 . - 28. Other payments ‘(from line 65). - 2 ee ee 128 | - _ NT
a
© Bi "| 29 Totat edd i lines 26; 27, and and 28) . a oe 8
a a ee re a ——
a} 2)
aa 30 If line 25 i is larger than line 29, enter BALANCE DUE. Pay in full with return . . b> 73
, qo |: 231 If line 29°is iarger than line 25, enter OVERPAYMENT . o 2 oem | Sa
_ | & | 32, Line 31 to be: (a) Credited on 1971 estimated tax b> $ 3} (b) Refunded >
. _ : Fee eeeeg et parla, core that | have oxamined this roturn, including accompanying schedules and statements, and to the best of my knowledge and belief
ee 52> an _ _ »
Sg bo Your signat “Date Signature of p
2 ap BIC Iar serie “ dima rte aia
LAMBERT-M KEI
— "a signature (if filing jointly, BOTH must sign oven if only one had income) : “Radress 16633 -RE-MARKELL

; ENCINO, CALIF. 91316
NW 88326 Docid:32245535 Page 134

Page’ @ Form 1049 (1970) oe a Por Attach Copy B of Form W-2 here. >
Foreign Accounts Did you; at any time during the taxable year, have any interest in or signature or other authority over
(check. a bank: securities, or other financial account in a foreign country (except | in a U.S. military banking
facility operated by a U.S. financial institution)? . . Yes [1 Na.

appropriate, box) _V__f ""Yes,"" attach Form 4683. (For definitions, see Form 4683.)

PART I.—Additional Exemptions (Complete only for other dependents claimed on line 10)

—— rs ve ne en —

a3 @) NAME , ‘ : jb) ‘Relation. “| {) Months lived in your (d) Did “depend (e) “Amount YOU furnished { ry Amount furnished
f rst . + ship home, if born or died ent have incoms | for dependent’: 5 support, if | by OTHERS includ-
a Js . during, year write ‘B'' | of $625 or more? 100% write ‘ a ing dependent.

ct

aa Total number of dependents listed above. Enter here and on line 10. oe _ Doe
t

PART ti. —income other than Wages, Dividends, and Interest

r toss) (at een ‘F720 2

35 Business income (or loss) (attach Schedule Che we aan _ S

36 Sale or exchange of property (attach Schedule D). 2... . . (36| (1,000!00)
37 Pensions and annuities, rents and royalties, partnerships, estates or trusts, etc. 2. (attach Schedule 5). 37° cent fo
38 Farm income (or toss) (attach Schedule F) . 6... 2 ne a
39 Miscellaneous income (state nature and source) colaccesenceseecentereneennenetenenees canecneec contest ttecececesenenectnaatens i

40 Total (add tines 35, 36, 37, 38, and 39). Enter here and on line 15

PART Ili.—Adjustments to Income

cnn erage engines stam ates eka naman, | ammeter

-41 “Sick pay" if included in line 12 (attach Form 2440 « or other required statement) .
42, Moving, expense (attach Form 3903) . Loe
43 ‘Employee business expense (attach Form 2106 or other statement) .

i 44 Payments as a self-employed person to a retirement plan, etc. (attach Form 2950SE) re i _

45 Total adjustments (add lines 41, 42, 43, and 44). Enter here and online 17...

PART 4V;—Tax Computation . ; “
46 Adjusted gross income (from line '28) : Loe tot _ Do 46) 7,284 19?

47 (a) lf you itemize deductions, enter total from Schedule A, line 222 : | i
(b) ‘If you do not itemize deductions, and line 46 is $10,000 or more, enter toe ee ee LAA 2,745 (44
S $1,000 ($500 if.married and filing separately) | ;
- 48 Subtract line 47 from line 46... Coe ee et [4B fe 539) 53
49 Multiply total number of exemptions claimed on line ul, ‘by $625 . Lo . (49) 3,790) 00
50 Taxable income. Subtract line 49 from line 48. (Figure your tax on this amount t by using Tax Rate i
Schedule X, Y, or Z-unless the alternative tax or income averaging is applicable.) Enter tax on line 51 50. ee") (33

51 Tax. Enterhere and online 19. . . . ee

PART Y. —tredits

52 Retirement income credit (attach Schedule R) . ee PIE
53 investment credit (attach Form 3468)... 2. 2. 0 2 ee ee ee ee BB
54 Foreign tax credit (attach Form 1116). . Ce eee ee | BAL _:
55 Total credits {add lines 52, 53, and 54). Enter here ‘and on n line 22. So eee mm 5B

PART Vi Other Taxes

56 Seif- employment tax (attach Schedule SE) . .

57 Tax from recomputing prior- year investment credit (attach Form 4255) .

58 Minimum tax. See instructions on page 7. Check here (1), if Form 4625 is attached .
59 Social security taxon unreported tip income (attach Form 4137).

60 Uncollected employee social security tax on tips (from Forms W-2) .
61 Total (add lines 56, 57, 58, 59, and 60). Enter here and on line 24
PART ART _VII.—O' —Other Payments

area nett nna nts ape aap ees oe die menbaeti eine oo tte

62 Excess F.1.C.A. tax withheld (two or more employers—see instructions on page 7) . . . . 62 _
63 Credit for Federal tax on gasoline, special fuels, and tubricating oil (attach Form 4136). . . . 63 eee ee
64 Regulated Investment Company Credit (attach Form 2439). . 2. 2. we ee ee | 64 a i
65 Total (add lines.62, 63, and 4. Enter here and online 28 .. ee eS |

Srivty vy U.S, GOVERNMENT PRINTING OFFICE :1970—\.>-370-040 94.1149624 : 1G—-SUTON-1

NW 88326 Docld:32245535 Page 135

Schedules AaB—Itemized Deductions AND |
- {1970

(Form 1040) == 8 Dividend and Interest Income
. . Department of the Treasury
' . Internal Revenue Service => Attach to Form 1040. .
Name(s) as shown on Form 1040 r Your Social Security Number

Samuel and Phyllis Ruby | 322) 12).7997

Schedule A—lItemized Deductions (Schedule B on back)

| Contributions. —Cash— including checks, money orders, etc.
(itemize—see instructions on page 8 for |
examples) | _ - —

a Medical and dental expenses (not compensated by insurance
Lk vos or otherwise) for medicine and drugs, doctors, dentists, nurses,
, - hospital care, insurance premiums for medical care, etc.

‘1 One half (but not more than $150) of In-

surance premiums for medical care. . |

me 2 Medicine and drugs. . . i a a [nn
Z 3 Enter 1% of line 18, Form 1040... | _|.

—_ 4 Subtract line 3 from line 2. Enter differ: | i

ence (if less than zero, enter zero). .{_. jd.

5 Itemize other . medical and dental ex- . ae

-‘penses. Include hearing aids, dentures, ,

eyeglasses, transportation, balance of in-

surance premiums for medical care not |

entered on line 1, etc.

11 Total cash contributions a
-12 Other than cash (see instructions on
page 8 for required statement). Enter
total for such items here. ©. 2 6 io
13 Carryover from prior years (see in-
structions on page 8) . - oe
14 Total contributions (Add lines 11,
12, and 13. Enter here and on line
19, below. See instructions on page 8

EL tor timitation) > 280) 00
| |__| Interest expense—Home mortgage . ae
_ __._| installment purchases . jo
__ _ 7 |__| Other (Itemize) ee !
6 Total (add lines4.and5).°.°. 0. 3 ej a .
"+7 Enter 39% ' of line 18, Form 1040. 2 |
~ *"-. 8 Subtract line 7 from line 6. Enter differ- ae __
fue : ence (if less than zero, enter zero). . (|____ a i
.9 Total deductible medical and dental ex- | 15 Total interest e expense (Enter here and
‘” penses (Add lines 1 and 8. Enter here and on tine 20, below.) . . ss 1, 552 18
“on line 17, below.):. 150 00 Miscellaneous deductions for child care, |
Taxes.—Real estate. . . . so ee : _..|___] alimony, union dues, casualty losses, etc. |

State and local gasoline (see gas tax tables)

General saies (see sales tax tables) .
State and local income .

Personal property .

(see instructions on page 8).

ty

10 Total taxes (Enter here and on tine 18,
below.) . .

16 Total miscellaneous deductions | (Enter i
here and on line 21, below.) . b>!

Summary of Itemized Deductions

17 Total deductible medical and dental expenses (from line 9). Cee ee kk ee . wal

: 18 Total taxes (from line 10) |
_ 19 Total contributions (from line 14).

20 Total interest expense (from line’ 15). .

21 Total miscellaneous deductions (from line 16) . . é Ce a . . . |

i

i 22 TOTAL ITEMIZED DEDUCTIONS. (Add lines 17 through 21. Enter here and on Form 1040, line 47)S/A " 2474 2,745 4d 4u

16--81169- i

NW'68326 Docld:322745535 Page 136

_: NAME Samuel and Phyllis Ruby . __ IDENTIFICATION NO. 322=12-799?
ADDRESS. 16250 Bircher a. Granada Hills, California
SCHEDULE NO. A SCHEDULE OF DEDUCTIONS _ YEAR ENDED....-97.9.

| FEDERAL & STATE |

MEDICAL [ FeoeRa, | state || CONTRIBUTIONS
"4. ONE HALF OF MEDICAL INSURANCE |__ CHURCHES | 150 00}
(NOT OVER A 1 (6) fore) 1 0/00 . :
2, DRUGS AND MEDICINES ee 7 a _ _COMMUNITY CHEST/Un i
3. LESS: 1% OF ADJ. GROSS INCOME __ SALVATION. ARMY /GOODWILL INDUSTRIES _ /
4. NET DRUGS AND MEDICINES _t on ro __REDCROSS ee | _
5. DOCTORS/ DENTISTS an ‘|| _XMAS & EASTER SEALS _ |
OR. [| HEART FUND/CANCER FUND |
OR: { || PARTNERSHIP RETURN ; |
DR. 2 L _ i|_ PAYROLL DEDUCTION | i i |
oR. - ; _ OTHER ORGANIZED CHARITIES: | 100/00, —
OR. [| |/Boy Scouts 15 |00
DR. [| fT yieirl scouts 1500
OR al 7 2 i
OR, __ a ee |
OR. — TOTAL CONTRIBUTIONS! 280 100

a

TINTEREST (70 « (TO WHOM PAID) _

+ FEDERAL & STATE

MORTGAGE LOAN

* BALANCE OF MEDICAL INSURANCE
© NOT DEDUCTIBLE ON TOP LINE ~.

Too — -
TOTAL | INTEREST |

+ — a rane | panes | nceceneten neff men = Seen ce - 7 Sanne
ed oe | + Colonial Mtg. Coe 11,133 [10
oe — a ma a. _ —— +
ee ttn . i Lo INSTALLMENT LOAN : _ Z . .
a TF Ieeodbody cow 3.
_ __. a che Co. 119/12.
“MEDICARE | _ To TFirat thei Ft [89 |10
HOSPITAL 4 _! ifransworld. _§1 144 |.
: _ | evolving. Shareea(EA| 39 110.
. LABORATORY | _ . LL LL J

L 552 /18 |

TRAVEL FOR MEDICAL
S_AMBULANCE _

| | FEDERAL & STATE |

| ___-ALIMONY (EXPLAIN) |

GLASSES “oo |

“SAFE DEPOSIT BOX FEE

2, HEARING AID

UNION DUES

: PROSTHETIC APPLIANCES
- MEDICAL EXPENSES

__SMALL TOOLS (GOOD 1 YEAR)

TOOLS DEPRECIATION

LESS: REIMBURSED BY INSURANCE __ SAFETY EQUIPMENT |
Lee Ll JL UUNIFORMS (NOT cEN.weaRy |
| JELESS: 3% OF ADJ. GROSS INCOME ° VL tAUNORY & CLEANING
8 BALANCE (NOT LESS THAN ZERO) | AUTO MILEAGE en seven
9. TOTAL MEDICAL DEDUCTIONS| “TELEPHONE EXPUNSE (NOT REIMA.) fe
WINE 1 PLUS LINE 8) _ _EMPLOYMENT AGENCY FEES _ 7
‘TAXES . dot R DUES & SUBSCRIPTIONS _ /
“AUTO LICENSE (LESS REG. FEE) 42 | $2 INCOME TAX PREPARATION —__ | $0 |00
SALESTAX + Large Items) 170! 00; 170/00) orners Financial Publ. 4. 50 00
SALES TAX AUTO . ; TE ; . _ !
“REAL ESTATE TAX _ | 311/26) 311 26 | TOTAL MISC, DEDUCTIONS |
CASUALTY LOSSES (&xPLain)

|__PERSONAL PROPERTY TAX

STATE INCOME TAX

“007 cGAL. |

140

gas TAX 200QcaL. @ -

& _ o_o __ SUB TOTAL |
| DISABILITY INSURANCE | a ween LESS REIMBURSED BY INS. | | as
‘MISC. TAX aS EOE 22 | _ sup roan; |

"_ornens: _ CT “LESS $100.00 FOR EACH CASUALTY | _ i
vi | TOTAL CASUALTY LOSSES se
a ae og eg ee setae eevee ceevehene ee wet En FEDERAL
TDI. Seieowetios ome TOTAL TAXES) 95) dee Bireranl comentooctooad ned shes bbe TOTAL DEDUCTIONS | tL

| NW 88326 Docid:32245535 Page 137 ~

LAMBERT-MARKELL + 16633 VENTURA

ELVD,

25785 1 ayes sae

+ ENCINO, CALIF. 98140


ee

i

NW! 88326 Docld:32245535 Page 138

_18 Commissions tone Ce
. 19 Amortization (attach clatement) :
“20 Retirement plans, etc. (other than contributions made on your behalf—see separate

2

SCHEDULE C
(Form’. 1040)
Department of the Treasury

internat Revonuo Service .

» (Sole Proprietorship)

> Partnerships, Joint ventures, etc., must file on Form 1065.
& Attach to Form 1 :

‘Profit (or Loss) From Business or Profession 197 0

Name as shown on Form 1040 Social security number

. amuel-and Phyllis Ruby _ 322 112 17997
A Principat business activity ..FOQQ oc cc cccsssseeennceeeeene product cece “eapeseesessenneseneesneuepeetennuneenensevaeuvnneveenuneeneersteees
(For exomple: retaii—hardware; wholesale—tobacco; services—legal; manufacturing—furniture; etc.)

(See:separate instructions)
B Business name ... oNaCK Bar.

we C Employer Identification Number . 95 572 6 51 578
Bo Van_N Ca

Ly. :
ash; (2) [-] accrual; (3) [] other, ; (ZIP code) .

D Business address ..
E Indicate method of acce

F Was thare any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?
Yes: 8 NO. If “Yes,” attach explanation. .
G Were you required to file Forms 1096 and 1099 or 1087 for the calendar year 1970? (See “Item G" in separate instructions for Schedule C.)

() YES # NO. If "Yes," where were they filed? oo... cece ccc cccee sees cen soe sees teeter cette toesues eee ense tees neussetantuseteatente cue eeareraeestecissesseteesenteneesetecs

.Gross receipts or gross sales $0.00... eee . . seeneeee Less: Returns and allowances $.......-----.----------------. bn wee ene ee

2 Inventory at beginning of year ;(if different from last year's closing inventory
attach explanation) «6. 6. 6 ee ee Be veneee

3 Merchandise purchased $.. : , less cost of any items
withdrawn from business for personal t use 3 tassessceecarenseeeaeceesenaeeaeseceseeaeseenere Penn n Dee

4 Cost of labor (do not include salary paid to yourself) ee ee ee ee pee
5 Material -and supplies so woe. :

6 Other costs (explain in Schedule €-1) a

7 Total .of lines 2 through 6 0. ee eceneeetteeneteeeten sede SCHEDU E
8 Inventory atendotthis year 2. 2 1. 1 we ee ee bee ee . : ATTAC D
9 Cost of goods sold and/or operations (subtract tine Bfrom line 7) © | ee ee

10 Gross profit (subtract line 9 from line 1) a
OTHER BUSINESS DEDUCTIONS me

11 Depreciation (explain in Schedule C-2) . woe ee a On

12 Taxes on business and business property (explain in Schedule 2 1) enn Sere

13 Rent on business property Sr ic See

14 Repairs (explain in Schedule C-1) . . . 20... to, ee

15 Salaries and wages not Included on line 4 {exclude any paid to yourset Fe ae Sn

16 Insurance . . .... se ee 5

17 Legal and professional ¢ fess . 2. 2.

instructions) ° on
1 Interest on business indebtedness
"22 Bed debts arising from sales or services... tk wk eo
23 Depletion. ... Oop te ee ee . _ oe ee }
24 Other business expenses (explain in Schedule C1) rn
25° "Total of lines 14 through 24... . a _—_—
26 Net profit (or loss) (subtract tine 25 from tine 10). Enter here and on line 35, Form 1040. ALso enter on . ,
~ Schedule SE, Part i, fine 1. 9,284
; . SCHEDULE c-1. EXPLANATION ¢ OF LINES 6, 12, 14, AND 24
Line Na. Explanation Amount _tine No. “Explanation TY Amount - 3

186—8NI71-1

1 Net earnings {or loss) from self-employment— ~

on anu

SCHEDULE SE | Computation of Social Security Self-Employment Tax

(Form. 1040). & Each self-employed person must file a separate Schedule SE

Department of the treasuy | pe attach ta Form 1040.

> Hf you had wages, Including ‘tips, of $7, 800 or more that were subject to social security taxes, do not fill in this page.
&> If you had more than one business, combine profits (or losses) from all of your businesses and farms on this Schedule SE.

Important.—The self-employment income. reported below “will be “credited to ‘your “social “security record and used in figuring social ‘Security benefits.

Name of self-employed aby (as shown on social security card) Social security number Check applicable block
Samuel Rub y os | 322 112: 7997. |1 i Male 2 [) Female

Business activities subject to self- “employment tax (grocery store, sStaurant farm, etc.
| Computation of Net Earnings from BUSINESS Self-Employment (other than farming) -
8,284 | jae

1: Net profit (or loss) shown in Schedule C (Form 1040), tine 26. (Enter combined amount if more than one business.) .
2 ‘Net’ income (or loss) from excluded services or sources. included on line 1 wo

Specify. excluded Services OF SOUPCES.......:c. cc ccecceesseseeeserieeteerstsneeuttnenestentcnatenss Ceassesesinteeeeeneets secedesteecenevenseeesseseees
3° Net learnings (or lost) from business self-employment (Subtract line 2 from line 1, and enter here and on line 1(a),
Part tl, below.) : -

uPart Wie! "Computation | of Net “Earnings from FARM Self Employment
A farmer may elect to compute net far. n earnings using the OPTIONAL METHOD (line 3, below) INSTEAD. OF THE REGULAR ME HOD (line 2, below)
if his gross profits are: (1) $2,400 oF less, or (2) more than $2,400 and net profits are less than $1,600. If your gross profits from farming are
not more than $2, 400 and you elect to usa the optional mathod, you need not complete lines 1 and 2.

Boo - Computation under Regular Method - |

1 Net farm profit (or loss) from: — \

(a) Schedule F, line 52 (cash method), or line 69 (accrual method)... . 1. ee ween eee eee ; woneee

(b) Farm partnerships « Fc sleek a ee er

2 Net earnings from selt- “employment from farming. Add tines 1(a) and (b) .
‘Computation under Optional Methad

3 if gross profi its from farming are:* .. :
(a) Not more than $2,400, enter two- thirds of the gross profits . . . . ek a ee

(b) More than $2, 400 and the net farm profit is less than $1,600, enter $1,600 :
°Note. —Gross profits trom farming are the: total of the gross profits from Schedule F, line 28 (cash method), or line
67 (accrual method), plus the distributive share of gross prafit trom farm Partnerships as explained. in instruc

~ tions for Schedule SE.
4 Enter here and on line 10), Part Hi, below. the amount on line 2 (or line 3, if you use the optional method)

* (a) From business (other than farming—from line 3, Part 1, above) .
_ (b) From farming (from line 4, Part Il, above)... one
9. From: ‘partnerships, joint ventures, etc. (other than farming) Co ee aS . .
: Ad) From: service’ asa minister, member of a religious order, or a Christian Science practitioner. If you’ filed Form
4361, check here a and enter zero on this line « os .
(e) From service with a ‘foreign government or international organization Co ee eee ee
“(f) Other (director’ 5 feas, etc.). Specify... wee nt enn ceneo ene newenee Leneeca cea tecneetentees sntewscnmevecneneus iueensuececescaedae A
2 Total net earnings (or loss) fram self- “employment reported online il . |. - . , toe
(ifline 2 is less than $400, you are not subject to self-employment tax. Do not fill in rest of page. ) ,
3 The largest amount ‘ot combined wages and self-employment earnings subject to social
security taxis... cr
4 (a) Total “FICA” wages as indicated on Form W-2 :
“*(b) Unreported tips, if- any, subject to FICA tax: from Form 4137,

line 9: we ee eb ee ;
(c) Total of tines Ala): and 400): . ee ee
Balance “(ubtract line 4(c) from tine 3) eek ew ke
Self-employment income—tline 2 or 5, whichever’ is smaller : coe te, ;
If line 6 is. $7,800, enter $538. 20; if less, multiply the amount on lirie 6by.069 ...... hoe ee
Railroad employee’s and railroad employee representative's adjustment for hospital insurance benefits tax from

Form 4469... 0°... ee ee ew we ee see ke
Seitemployment tax (subtract line 8 from tine 7). ‘enter here and on Form 1040, line 56 538 120 20

16—81171-1 ope

NW 88326 Dochd:32245535 Page 139

Samuel and Phyllis Ruby

SUPPLEMENT TO SCHEDULE C

Income: , $32, Onn. 34,
Less: Sales Tax 153-39: » $32,503.95
"Beginning inventory |
Purchases - Beverages/milk  . $ 1,988.55
Groceries 8,761.69
Meat ee , 1,893.83
Bakery/bread . a 2,412.82
: $15, 15,056.89 :
Lessi Ending inventory - 7 "890.00 00 14,256.8
Adjusted Gross Profit $18,247.20
- Expenses. .
Rent ©. Lo . $ 1,172.16
Payroll. . 2,046.30
Payroll taxes . 202.92
Travel to employees 215-00
Miscellaneous expense , ; ' 219-40
Interest. an - 419.10
Accounting. — 225.200
Telephone .. . _ ; FBS
Repairs. a ~121.40
Insurance 150.00.
“Linen - 21.00
; ; Auto - 3, 000 Me © . ; 360.00 |
. Office « - — - 360.00.
.Cleaning/maintenance . : ‘50.00 ~ co
Depreciation | ; ee 32321-36 -( _8,962.09)
“Net Profit. ; ae . $ 9,284.97
DEPRECIATION
Equipment . 4/70 $10,000.00 7 § Yre. $2,000.00
-Covenant Not To . ;
. Compete ; ; : 5,000.00 - ; 5 Yre 1,000.00
Leasehold Imp. : 3,000.00 7 Yre 428.50
(7? Yre Balance Lease ) mo . ; _
- ; : April-December, 1970. | $4, 428750

_ NW.88326. Docid:32245535 Page 140

NW 88326

SCHEDULE D.
(Form 1040) .

Department of the Treasury
internal Revenue Service

- Sales or Exchanges of Property

® Attach to Form 1040.

Name(s) as shown on Form 1040

samuee and Phyllis Ruby

322
[Capital Assets—Short-term capital gains and losses—assets held not more e than, 6 months

Social Security Number

12! 7997

. . . c. How h. Cost or other
a, Kind of prop- b. Description _ tage basis, cost of
i : quired. g. Depreciation ; .
ory incicae SExgmiptes; 100 ah. of || Enter Kcqured | 2 Date sold | f. Gross sales | allowed (or subsequent improve
estate, or other |: z" Co., ‘te mye brick, set (mo., day, yr.) |(™- day. ¥F-) price a oi purchased, attach
(specify) . explanation) and
(seo : expense of sale

i. Gain (or loss)
(f plus
g less h}

. Enter your share’ of, net ‘short- term gain ‘(or Joss) from partnerships and fiduciaries |
Enter net gain (or loss) from tines 1 and 2 :

Enter unused short-term capital loss carryover from preceding taxable years ‘(attach statement
Net short-term gain (or loss) from lines 3 and 4

Long-term capital gains | and | losses—assets eld more than 6 mo onths

mine wp

, Capital gain distributions.

. Enter gain. from. Part VII, line 47 or line 51(a), whichever applicable

Enter your. share of ‘net lang-term gain (or loss) from partnerships and fiduciaries
Enter.your share of net.long-term gain from small-business corporations (Subchapter 8).
Net gain (or loss) from lines 6 through -10

Enter unused long-term capital loss carryover from n preceding taxable years attach statement)
Net! Jong: -term gain (or! loss) from lines 11 and 12.

Combine the amounts shown on lines 5 and 13, and enter the net gain (or loss) here —

If line 14 shows a gain— :

(a) Enter 50% of line 13 or 50% of line 14, whichever i is smaller (see Part IV for computation of alternative

. tax). Enter zero,if there is a toss or no entry on line 13

(b) Subtract ‘line 15(a) from line 14, Enter here and’on line 17, Part i!

If line 14 shows a loss—

(a) Add tines 4 and. 12 (if lines 4 and 12 are blank, enter a zero here and on lines 1600) -and 16(c) and go
‘to line 16(d)). : ok woe ke

(b) Combine lines-3 and L1—it 5 gain, enter gain; it loss, enter zero

(c) Enter smallest of (i) line 16(a) less line 16(b); (ii) line 48, Form 1040 (line ‘18, Form 1040 if. tax
table used) disregarding capital gains and/or losses—determine this figure via a side computation;
or -(iii) $1,000

“(d) Combine lines'3 and 11—if loss, enter loss; if gain, enter zero 5 here and on line 16(e),
and go to line 16(f) . /

- (e) Enter smallest ‘of i) line. 48, Form 1040 (line 18, Form 1040 if tax table used) disregarding capital

fins and/or losses, less line 16(c)—determine this figure via a side computation, (ii) $1,000 ($500

if married and filing separately); (Iii) if line 3 ig zero or shows a gain, 50% of line 16(d); (iv) if line
‘1 is zero or shows a gain, amount on line 16(0); or, w if lines 3 and 11 show losses, line 3 added

to 50% of line 11.
BkGGh 4p t ae reane ir

(f) Enter here, and on tne 17, Part r the sum of lines 5 16(0) ang,

16

than $1,000) . .
Summary of Schedule D Gains and Losses

( 1,000.00)

17 Net gain (or loss) from line 15(b) or 16(f), Part |
18. Net gain (or loss) from tine 22, Partlll .
19 Total net gain (or loss), combine lines 17 and 18. ‘Enter here and: on ‘ine 36, Form 1040

070 kA

Docld:32745535 Page 141

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732745535 Page 142

NW 88326 Docld

TAXABLE

CALIFORNIA

INDIVIDUAL INCOME TAX RETURN

® So Fe of

For Calendar Year 1970 or Fiscal Year Begun 1970 and Ended 1971
FIRST NAME(S) AND INITIAL(S)- LAST NAME Your sotial security number

~, SAMUEL AND PHYLLIS _ RUBY 322 | 1217997
TY, TOWN OR POST OFFICE Sate : ZiP CODE — Your occupation
California 9134s
Self-Employed | Housewife
11346 Montgomery Avenue © Granada Hills, Calif. _||f sitterent tom tig tan

Typo. r. PRESENT HOME ADDRESS (Number and street, or rural route) \
=- s+ 16250 Bircher oo Los Angeles} 349! 18; 1420
Granada Hills. Self-Employed
- NAME AND ADDRESS OF EMPLOYER AT TIME OF FILING Spouse's occupation
een ee a
‘NAME AND AODRESS ON 1969 CALIFORNIA RETURN. IF SAME AS ABOVE, WRITE “SAME”. IF NONE FILEO, Adjusted gross income on 1970 Federal
GIVE REASON. ‘ Return §.-.- 39204297...
Filing Status 1. |__| Single 3. |__| Married, filing separate return-—spouse’s Mame: eens
(check one) — 2. | X | Married, filing joint return 4. || Unmarried “head of household’"—Complete Part I, page 2
5. Wages, salaries, tips, etc. (before payroll deductions) if more than two employers, attach schedule

If different from line 11, below, explain
Employer's name Where emptoyed (city and state)

COUNTY Spouse's social security number

Hf Joint return,
‘Include all ©

income of .
both husband . oe 7 oo :
‘and wife " 8. Dividends. Enter total here (also list. in Schedule B (540), Part |, if total is over $100)... . . 22. LM LOM.
74 oe J. Interest. Enter total here (also list in Schedule B (540), Part ll, if total is over $100) . 2. 2. ee Gere :
BST 7
ag Ek a ; .
2 on 8. Other. income (from page 2, line 30) 2 6 2. ee 8
“—E G, Total (add lines 5, 6,7 and) 91...32305 [52
Cae | + 10, Adjustments to Income (from page 2, line 39). ee | TO
iS : a _—
=. 11. Adjusted gross income (subtract line 10 from fine 9) 2 2 2 2. 2 ee ee ee fd

if you do not itemize deductions AND Jine 11 is under $10,000, find your tax in Tax Table in instructions. Enter tax on line 12.

‘Your © If. you itemize deductions OR line 11 is $10,000 or more, g0 to Part IV on page 2 to figure tax. .
Tax, 12. Tax from (check one): Tax Table [7], Tax Computation (page 2, Part IV) Qg, or Schedule G.(540) on 12 fovecerenes
and 13: Exemption credits (from page 2, Sine 43) ; rn 13
Credits 14. Tax Hability (subtract line 13 from fine 12). ee Pa RE
: : 15. Total other eredits {from page 2, fine 49) 2 2. 2 2 ee ee ee ES
16. Net tax. lability (subtract line 15 from line 14—If $1.00 or less, enter “zero”) . 2 2... . | 16

an 17: 1970 California estimated tax payment or credit from 1969 (if any). If none, enter 1) ae 1 © A or .

Balance 18. Batance due—if any (subtract line 17 from fine 16) . . . . . . . . . “PAY IN FULL WITH RETURN 8 :
Bue or 18:’ Overpayment—if any (subtract lIne"16 from line 17)... 2 1. ee. OVERPAYMENT | 19

* Rofund 20, Portion of line 19 you wish to apply on 1971 estimated tax re 20 [>

fou 21. Rofund—if any (subtract line 20 from tine 19) 2 2 2. 2 eee ee ee. REFUND
|
T

ae

—

" ‘Under penalties of perjury, | declare that 1 have examined this return, Inetuding accompanying schedules and statements, and to the best of my knowledge and
. ‘ .,, belief it is true, correct and.ecmplete. If prepared by a person other than taxpayer, his declaration is based on alt information of which he has any knowledge.

here > sscaai signatare, . * eaten 1 | Sainhel [i nrinnannr Adare AMBERT-MARKEL aig
16633 VENTURA BLVD.

© Make Remittance Payable to FRANCHISE TAX BOARD—Mall fo pi iio, CALIF: . 91316
FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95814. © — :

- NW. 88326 .Docld:32245535 Page 143

. ?

* _ Form 540 1970 Page 2

“PART |—Head of Household—If claimed, answer the following questions (See Instructions)
Check -O Nevér married (] Final divorce/dissolution QO Separate maintenance = [_] Widow(er) ”

Date... eee eeee Date.
: Relationship... _.. ey \-\ eee Grossi income $. woeceneneeneeeeeee
Is this person married?........ -....If yes, did he or she file a joint return with spouse? ..... ... Did this person qualify as your dependent for
the calendar year 1970?:.......... Did this person reside in your home for the entire ‘taxable year?..........If not, explain circumstances

cane ncnnne nan aameten: peene hammer erent

Total amount necessary to maintain in household $.

PART. i—Other Income’

. 22. Business income (or :toss) (attach Schedule C (540)) Loe, : :
23. Sale “or exchange of property (attach Schedule D (540). ©.) ee PRBS

24, Pensions and annuities’, \ ot. %e toe ee Te ee eT Cn ye 24

25. Rents and royalties > Attach
: Schedule E
. c (Form 540)

26. Partnerships

27. Estates or trusts

28. Farm income (or loss) (attach ‘schedule p 640))
29. Miscellaneous income (state nature and source).......:

ak

30. Total edd fines 2 ‘through 23). ‘Enter ‘here ‘and ¢ on page 1, ‘Tine 8.

PART Ill—Adjustments to Income
81. “Sick pay” if included on page ‘1, fine 5 (attach statement)... ee) ore
32. Moving expenses (attach statement) 2 0 ee ee ee BR fe
33. Employee business expense (attach statement) .

34. Military exclusion (maximum $1,000—-$500 if separate return of husband or r wife)
35. Tota! adjustments (add lines 31 through 34). Enter here and on page 1, line 10

PART V—Tax Computation—It you do not use Tax Table or Income Averaging (Schedule G (540))

36. Adjusted gross. income (from page 1, line 11) . . os
37, if you itemize dedictions, enter total from Schedule A (540), line 31
If you do not itemize deductions, and line 36 is $10,000 or more, enter
(a) $1, 000, if singfe, or married person filing separate return
__ (b) $2,000, if head of household, or married couple filing joint return
38. Taxable income {subtract line 37 from line 36) . .
-39.. Tax from Tax Rate Schedule in Instructions. Enter here and on page 1 line 12

PART V—Exemption Credits ee

40. Single—$25. Married couple or head of household—$50~. 2 2. eo 501 00.
41. Blind =) Yourself Your spouse—$8 for each box checked Lot ek Of /
42. Dependents—Do not list yourself, your spouse, or person who qualifies you as head of household ; .

NAME (and address if different from yours)- . . RELATIONSHIP

Thomas » ; . .children

Fred, Brian, Elisa,

Number of  dopondents listed...
43. Total exemption credits (add lines 40, al and 42). Enter hare and on page 1 Tne 13

PART Vi—Credit for Net Income Tax Paid to Another State—Attach copy of “other state” return—and Retirement Income Credit

44. Income derived from sources within State of .. ‘and also taxable by California 2. 2. 2 Le we eeenlenlacecceceuedfeseee
45. California adjusted gross income (from page 1, fine 11) 2 2 1. we eee | AS ;
46. California tax liability (from page 1, line 14) 2 2. ome . eo | 46 J: es hee :
47. Credit limitation—line 44 fine 45 oe. % (100%: inaximum) x "tine 16 (cannot ‘exceed tax ‘paid other state) we | A
48. Retirement income credit (attach Schedule R (540) 2 2... ee | AB

49. Total (add lines 47 and 48). Enter here and on page 1, fine 15

oc 45149-4090 7-70 13,000m@ A osp


CALIFORNIA

ITEMIZED DEDUCTIONS

Attach to Form 540

SCHEDULE

A al ,
. FORM 540
Social Security Number

Name as shown on Form 540 :

Samuel and Phyllis Rub 322 112 | 7997
{temized vs. Standard Deduction—You have a choice between two deduction if one spouse itemizes deductions, the other may not use the Tax Table or claim
methods. You can either itemize your deductions or take a standard deduction as the standard deduction. If you choose to itemize your deductions, complete the
explained in the 540 instructions. On separate returns of a husband and wife, appropriaie items below.

Medica and dental expenses (not compensated by insusance or otherwise) for medicine and drugs, doctors, dentists, nurses, hospital care, insurance
premiums for medical care, etc.

. One haif (but not more than $150¥'0 of insurance premiums for medical care

1 woe
2. Medicine and drugs . 2°

"3. Enter 1% of adjusted gross ‘income “shown on Form 540° 3

_ 4; Subtract line 3 from line 2 (if less than zero, enter zero) 4
§. Other medical and dental expenses. Include balance of insurance premiums fot medical care not -

_ deducted on line 1 (attach schedule) 5
6. Total—(Add lines 4 and 5) «© © wu. 6
7. Enter 3% of adjusted gross income shown on Form 540 7
8: Subtract line. 7. from fine 6 {if less than zero, enter zero)

9. Total—(Add lines 1 and 8)

Child Adoption Expense
10.- Total expenses paid or incurred—Attach itemized list :

11. Enter 3% of adjusted. gross income shown on Form 540

12. Subtract line 11 from line 10—See instructions for maximum limitations

Taxes” wo . . .

"43. Real estate. 0 who
14. State and local gasoline en ee Pe db. i
15, General sales... . : ee PTB pe
16. Auto license—-Excess of registration and weight fees tee instructions) . ae Oe |< ee
17. Personal property. . . 1 es cee
18. State disability insurance (S01) —Employer private disability bias éo not st quality Wyo.
519. Other (specify) . - cescueeseeendsteeeeeetnntnee ned coeneacennune daceetetchaantis dageeeniene sats getnans san secteennceene . ow 719
20. Total taxes——(Add lines 13 through 19) 0 | 20 663] 26
Contributions oe , °
21. Cash—Including checks,: money orders, etc. (itemize) cesciig ecepnteee tee te seteced ce cages eeeeeadenige vce tegamats tenets ceenmecrtmesianememee s POL Lice enfin
22. Total’ cash contributions : an a ;
23. Other than cash (see instructions). Enter total here : Ce :
24. Total—Add lines 22 and 23—Maximum deduction may not exceed 20%. of adivsted gross income . . ww. 00

Interest Expense . : _ .
25. Home mortgage . 2... ee
26. Installment purchases —

27. Other (itemize) .

28. Total—tAdd lines 25, 26 and 27). rs 1,552118

Miscellaneous Deductions . ;
29. For child care, alimony, union dues, casualty losses, etc—See instructions (itemize). 2... cc. ccccce cucsececsseeceeescesevnssesteweeeeeeccessevtecreeneeees | 29

30. Tota miscellaneous deductions ren > | 30 100} 00
a a
_ 31, Total deductions—Add lines 9, 12, 20, 24, 28 and 30). Enter total here and on Form 540, page 2, in space provided S/A. 3) 25745] |

Schedule B on reverse

NW'88336 Docid:32245535 Page 145

TAXABLE

CALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships)

FORM 540

Partnerships, joint ventures, etc., must file on Form 565
Social Security Number

322 j2

Attach this schedule to your Income tax return, Form 340 or 540NR

Name as shown on Form 540 or 540NR
Samuel and Phyllis Ruby

A. Principal business activity...... Lo X Fa 2). | EEE
, (For example: rotall~hardwaro; wholosale—tobacco; services—legal; manufacturing—furniture; ete.)
B. Business name _Snack Bar. cee ce anne tectnamecens __.. €, Federal employer identification ns 25 51. 578.
D. Business location.. 5418 Van Nuys | Boulevard “Van Nuys, California 91401
ae {Number and stroet or rural route) ; L : (City—post office) (State) (zip “code)

Indicate method of accounting: RK) cash; C] accrual; oO other (describe)

F. Was there any substantial “henge. in the manner of determining “quantities, costs or valuations between the opening and closing
inventories? [1] Yes No. if “yes,” attach explanation.

G. Were Forms 591, 592, 596 “and 599, for the calendar year filed (if required)? []Yes K] No

1.: Gross receipts or gross sales $__.........--...- ecssneeenussens Less: Returns and allowances $........------------- ne ee] Gee ep
2. Inventory at beginning of year (if different than last year’s closing inventory attach .
- explanation). . Ca

, less ‘cost of « any items $ with-

3. Merchandise purchased $
“.. . drawn from business for personal use $....-.. sneennnesoseees
4. Cost of labor (do not include salary paid to yourself)
5. Material and supplies _ soe ee
' 6. Other costs (explain in Schedule C. 1) re
7. . Total of lines 2 through Bn Lene dieeerecee tec enne tence:
8. Inventory at end of this year . cone
9. Cost of goods sold and/or operations (subtract line 8 from line 7).
‘10. Gross profit (subtract.line 9 from line 1). .
‘OTHER BUSINESS DEDUCTIONS |
11. Depreciation (explain in Schedule C-2) . oo
12. Taxes on business and business Property (explain i in Schedule C. 1 a ee ;
13. Rent on business property ... fe eee ate ates _
14, Repairs (explain in Schedule c 1) re : rs .
15. Salaries and wages not included on line 4 (exclude any y paid to - yourself) rr ae
16. Insurance .. soe ;
17. Legal and professional ‘fees | ceteeeenee cecteneecee tues
18. Commissions . : |
19. Amortization (attach statement)
20. Retirement plans, etc. (other than your share) .
21. Interest on business indebtedness .
22. Bad debts arising from sales or service; .
23. Losses of business property (attach statement) -. :
24. Depletion of mines, oil and gas wells, timber, ete. (attach schedule) .
25. Other business expenses (explain in Schedule C-1)
26. Total of lines 11 through 25. 2.

. Net profit (or loss) (subtract line 26 from line 10). Enter here ‘and on page 22, Part IL Form 540 or '540NR

” (Rev. 1970) . Page 1
: NW 88326 Dochd:32245535 Page 146 _

., L SCHEDULE

CALIFORNIA | ae :

~ SALES OR EXCHANGES OF PROPERTY

* co. * Attach to Form 540 or S40NR

Social Security Number,

322 | 12! 7997

Name as: — Form 540 or S40NR i
«-. Samuel and Phy? i's Ruby

Part I-CAPITAL ASSETS
SHORT-TERM--ASSETS HELD NOT MORE THAN 6 MONTHS

f. Cost or other basis,

att one, . oe . oti
mm e. Depreciation allowed cost of subsequent
a _ attach of prot it weeny, vi Date, aeauired Pa Date sald d. Gross sales price (or allowable) improvements Ai not & Gain or a
. oa . mo., day, yr. ‘mo., day, yr. * since acquisition purchased, attac! Pp jus ¢ fess
detaits not shown below) 7 (attach schedule) explanation) and

expense of sale

“2. Enter your share of net short-term gain (or loss): from partnerships and fiduciaries
: 3. +Enter unused short-term capital loss carryover from preceding taxable years (attach statement)
4. ‘Net short-term gain (or loss) from lines 1, 2 and’ 3

LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS
3. “Enter goin (if any) from line 16, Part it. OR ee ee fo

6. “Enter your. ‘share of net Tong. term gain n (or loss) from partnerships and fiduciaries
‘7. Enter unused long-term capital loss carryover from preceding taxable years (attach statement)
8. ‘Net long-term gain’ (or loss) from lines 5, 6 and 7

(15,274.00)

sO -Céibine the aiviounts shown ¢ on lines’4 and 8 and enter the net gain (or loss) here
10. ‘if line 9 shows a GAIN, enter 50% of line 8 « or 50% of fine 9, whichever is smaller. (Enter ; zero ‘if there i is a
.. loss.or'no entry on line 8)". . . Ce ee ee fe :
“PH. Subtract line 10 from line 9, Entor here and on ‘line 17, Part il . :
12. If line 9 shows a LOSS, enter here and on line 17, Part II the smallest of the following:
(a) the amount on line 9; (b) the amount of taxable income on Form 540 or 540NR, computed without capital

gains and” fosses;‘'or (c) $1,000 Carryover Loss (14,274.00)-

Part N-SALE OR EXCHANGE ‘OF PROPERTY UNDER SECTIONS 18181-82

13. Enter gain (if any) from line 22, Part IV
14. Enter gain (if any) from line25, Part IV

oan

15. Enter your share of gain (or loss) of Section’ 18181-82 items, from partnerships and fiduciaries
16. ‘Net gain (or loss). If GAIN, enter on line 5, Part |; if LOSS, enter on line 29, Part V

' PART 1l-TOTAL NET GAIN OR LOSS FROM SALES OR EXCHANGES OF PROPERTY
17. Net gain (or loss) from line 10 or 11, Part | vt ;
‘18. Net gain (or loss) from line 31, Part IV ,

19. Total net gain (or loss)—Combine lines 17 and 18. Enter here and: on . Form 540 « or Form 540NR, poge 2, Part
H, fine 23 . soe ee : roe .

(Rev. 1970) (Schedule continued on reverse) : Page 1
NW 6326 Docid:32245535 Page 14f

PERS worzepiiete | a3a-agod.

3H!

U) S Department of the Treasury / Internal Revenue Service ~ 960
Individual imcome Tax Return @ 19

.. 1969, endin

For neler ‘January 1-December 31, 1969, or other taxable year beiNNiNg ............. .-eceereseereeeretecs

First namo-ond initial (If joint return, use first names and middle initials of both) Last nome . Your si security a
5 |
E . LL
'E Homo address (Number, and street or rural route) 7
g
F City, in or post office, State and iP co code * - ‘ Spouso's soial security number

'
1 '

Fa
Enter below name and address used on your return for 1968 (if same as above write Same’). If none filed, give

reason...If changing from separate to joint or joint to separate returns, enter 1968 names and addresses. Spouse s occupation

‘Your present employer and address

Your: | 2 (] Single to Ss j 4 (J Unmarried Head of Household
aie ~~}.2 [1] Married filing joint return (even if only one had income) - ; 5 (J Surviving widow(er) with dependent child .
US— | Married filing separate return and spouse is also filing a return. 6 M. fil
- (Check | 30 If this item checked give spouse's social security number in ‘space provided - is sot equineaee file return ane spouse
" only. one)!. above and enter first name here

Pour 65 or over Blind '

The Check boxes for exemptions which ‘apply
‘on | 7a Yourself. . . . Loe a QO C7 | Enter
va : 5. -7b. Spouse (only if her (his) income is included in this return or, she (he) had no income) O . oO , oO oF oeKeS
“os. ] @ap 8 First names of your dependent children who lived with you ~~ j a
e| Eu. 7 ; Enter number >
: , E—Enter figure 1 i ° Ts _, | WoMonths lived 00 Su S
ELE fo omen | SiMe san, teus Line met Tw naan | MeMont | $500 | Supe s,| © oe
sf aw DEPENDENTS (if more space is needed, use other side) a page ‘2 of instr, income? | write ““ALL.’ others
-&£ 3. tf [ae a Se SETS
Ss 10 ;Total exemptions from lines 7, 8, and Sabewe. ee ne OD L :
5 my os , , = a 7 — a
, 8 a + Wages, salaries, tips, etc. Attach Forms W-2. If unavailable, explain on back. . le ee
F & | 12a Dividends “Belasion 3 ta = Hae sen 8) & Less 12b Exclusion $.... 2.0) Bi Banya 12c)_ 0 —
* ‘@e]-o : . tt : phos ¥
H =] 13 Interest (If over $100, list in Schedule B, Part ll)... ee ee 3) 465 7|—
zx 3. : . . . : . sy .
re ane 14 Other income from Schedule C (1, Schedule D (1, Schedule EO, ScheduleF OQ . . 14 —_
ag {Add lines 11 thru 14) (see back) os
os 15a Total, $ L b 4 7 — Less 15b Adjustments $ f_% ¢ ? , Adjusted Gross Income p>
x L oo A If line f5c is $5,000 or more, go to Schedule T, to figure tax and surcharge. (Omit lines 16a and 16b.)
_ flB 7 _B Also go to Schedule T, to figure tax and surcharge if you itemize deductions; or claim retirement income credit, foreign tax credit, or
yl ry 5 % investment credit; or if you owe self: -employment tax or. tax from recomputing prior year investment credit. (Omit lines 16a and 16b.)
. 8\x ¢ If neither A nor B applies use Tax Tables instead of Schedule T. Complete lines 16a, 16b, and 16c. See paragraph Do on back for
. & iS 2 rules under which the IRS will figure your tax and surcharge.
§ 5 16a: Tax from Tax Table: AO, BO, or C a “(check one) 16a ‘a =
m=) Ba) 16b Tax surcharge on amount on line 16a (see’ Page 10 of instr) 16b hm Vy YY i
: 4 : 16c Total add lines 16a and: 16b OR enter amount ‘from Schedule T (Form 1040), line 11. a
; = £. +17. Total Federal income tax withheld (attach Forms W-2) . . iz. ViKa“‘“é
wo 2 a) 18 © Excess F.I.C.A. tax withheld (two or more employers—see page 5 of instr.) . o : — ig money ordér pay- Z
‘O | 19 [ Nonhighway Federal gasoline tax—form 4136, [1] Reg. lnv.—Form 2439 | 29 | —— % able to Internal Z
met GAS Revenue Service. Z
2 20° 1969 Estimated tax payments (include 1968 overpayment allowed as a credit) - . 7 fT LLL
F >= Total (add lines 17, 18, 19, and 20) wee a i
y. ot ; : ; : aa
afsd). -' . toe
 &. as 22 Mf line 16c is larger than line 21, ———————-————_-> enter BALANCE DUE / 22 |
—81a6l:
=
Ez s& 23 s/f line a1 is larger than line 16c, ————————----—-—-P enter OVERPAYMENT
a <. 24. Line 23 to be: (a) Credited on 1970 estimated tax > $ ; (b) Refunded p> $

"Under penalties of perjury, | deciare that 1 have examined this return, including accompanying schedules and statements, ond to tho best of my know! ge and belief it
is true, correct, and complote. 1 .

a D sam signature : . _ Date’ * p> Signature of preparer ather than taxpayer, based on : Date
be . - all information of which he has any knowledge. ‘

Addross

vv) SCHEDULE. D’ Gains and Losses From Sales or Exchanges —
vo (Form 1040) |. € p ee ° a ‘ ; 1968
‘YAS. Treasury Department @ reper y

. Internal Revenue Service - Attach this schedule te your income tax retucn, Form 1040
: —— omen
' +’ Name as shown on page 1 of Form 1040 : : . Social Security. Number
et Part I-—-CAPITAL ASSETS—Short-term: capital gains arid josses—assets held not more than 6 months
rs a How ann { . rr H :

h, Cost or other |
basis, cast of

a a. Kind af prop. b. Description i quired. |

. i ‘ a.
. Ory, Indicate d. Date " 7 . zg. Gepreciation | subsequent improve-
security, real acquired the Date sold, ft Gross gales 1 altewed (or i ments (if nat i deli
estaie, or other. | ina. day, yr.) | Os. GBY, Yr. Pr { allowable) since | purchased, attech ~ | a
toe {

Specify) explanation) and

expense of sale

acquisition

2 Enter your ‘share at net short:teriy gain (or toss) from pz snershipg ahd fiduc’ _ . .
3. Enter unused’ short- -term capital lose” carryover from preceding taxable years {attach : statement). . 2. ee

4 Net short-term gain (cr loss) from tines 1, 2, and 3 Coe . re)
io meneame neen mens

Long-term capital gains and losses-—assets heid more than 6 months hs (12 months or more for certain livestock)

5 Enter gain from Part 1, fines... Oe ae ee ee i

et ae ea

Cia Total long: term gross sales price _ _ |” I

'
'

" 6a Enter your Share of net long-term gain (or toss) from partnerships and fiduciaries, 2 2, 5 6 ee aw : aos
vt 6b Enter your. share of net long-term gain from small business corporations (Subchapter 8}. 0. 2. toe eee
- 7 Enter. unused. long: -term capital loss carryover from preceding taxabl2 years (attach stalementy 2. 6 8 we ne
S Capital gain dividends (see Form 1040 Instructions, page). 2 Le Se woe
.3 Net long-term gain for ‘foss) from tines 5,6a,6b,7,and8. 2. 6. we ky ee ee ee ee bk

“40 Combine ‘the.: ‘amounts shown on fines 4 and 9, and enter, the net gain (or oss) Here - ey ee ae
‘11 iffine 10 shows a GAII~-Enter 50% of line 9 or 50% af line 16, whichever is smaller. (Ener zero if there is a loss ar no}

entry on line B.) (See reverse side tar computation of alternative tay ee hin ai
&2 Subtract. tine, 11 from fine 10.° Entor here and in Part IV, line 1, on reverse sidé. . 2... : ; =f
Loy en

A3 if line 10 shows. a LOSS-—Enter here and in Part IV, lina 1, the smallest of the following: (a) the amount on line 10: (by

the amount on Form 1040, page 1, geal 1b, computed without regard to capital gains or lcsses; or (c) $1, 000 Lteq 3 |
erent ttesenninrnatetinee nn nthe ne nner teen rr eevee nnenesceewar ene

Part il--GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245
assets held more than 6 months (see instructions far definitions)
Binera doudlts ‘neddings appear, use the first heating for section 1245 and the second heading for section 1250.

a. Kind of property and how acquired (if necessary, attach statement | @. Cost or other basis, cost of

fh bel t b. Date acquired Date sold L Gre f in subsequent improveriants (it
of descriptive “fo indiesto pe preent 8 1245 or 1250 imo., day yr) (nio., day. ye) d. Gross sales price not purchased. attach opie
nation) and expense of s3io

(oar neers een LLL CCE Ses “mm
~ £. Depraciation altowed (or allowable) since acquisition | : :

‘, _ : 1 Ordinary gain :

a fh Priat ‘1 fanuaty 1, 1962 | 4-2. After December 31, 1961 | g. Adjusted basis he Tota! gain closer or hz oh) 1. other gains >

as GR | 40 loss suri of £1 and t-23 id fess gy | reine pevtathieaiaden + (less ip
4a "After December 31, 1953 (see ‘astinetions)

'2 Total ordinary gain. Enter tere and In Part IV, line 2, on reverse side . i _

+8 Yotal other gain. Enter here and In Part I, line 5; however, if the gains do not exceed the losses when this amount is

gombined with other gains and losses from section 1231 property enter the tn tal at colunnt
acerca nee ranma

i
i
!
i


SCHEDULE T
(Form 1040)

Department of the Treasury
internal Revenue Service

Tax Computation

Attach this schedule to your income tax return, Form 1040

Social Security Numbsr

Name (as shown on Form 1040)

Tax Computation

1 Your adjusted gross income (from line 15c, Form 1040) .

Note.-—If your adjusted gross income is less than $5,000 and you choose to take the ‘standard ‘deduction
instead of itemizing your deductions, omit lines 2, 3, 4, and 5. Find your tax.in the tables on pages 10-12
in the instructions and enter it in line 6a instead of making a percentage rate computation.

Enter on the line at the right the amount of your deduction figured under one of oo |

methods: Lob
—lIf you itemize deductions, enter the total from Schedule A (Form 1040), line 14
‘OR

—Figure your standard deduction as follows:

(a) Enter 10 ‘percent of tine 1. ‘put’?
>not more than $1, 000 ($500 if
married and filing separately) .

ter the larger of (a) or (b) on the

Enter the sum of: $200 ($100 if
""cmarried and filing separately)
’ * plus $100 for each exemption

- claimed in line.10 of Form 1040,

line at the right. If your spouse files
a separate return, determine your
deduction in the same manner that

she (he) has.

but do not’ enter more than
: + $1,000 ($500 if married an
filing separately) fs

Subtract the amount on line 2 Q, the amount on line 1 and enter the balance here .

‘ Enter number of exemptions claimed on fine 10, Form 1040, - o Multiply this number by $600, and
enter the amount on this line .

Subtract the amount on line 4 from the amount on 1 line 3 and. enter ‘the balance here. “This i is your
taxable income .

a Tax: Use the appropriate Tax Rate Schedule on page 9 of instructions to figure y your tax on the amount on

fine a Le Ye oo

(Check if tax is from: Tax Table c. Tax Rate Schedule ‘oOo. Schedule D oO. or Schedule G Oo) “| 4 :

Tax ‘surcharge. \f line Ga is less than $730, find surcharge from tables on page 10 of instructions. If line 6a :

is $730 or. more, multiply amount on line 6a by .05 and enter result. (If you claim retirement income -

credit. use Schedule R (Form 1040) to figure surcharge.) . : an es a Dene
6c Total (add lines 6a and 6b) . Pap | iene

Special credits l
7a Retirement income credit . . 7
3 , i

; Th Investment credit
7c Foreign tax credit .

. 7d Total (add lines 7a, 7b, and 7c)...

8 Income ta tax (subtract line 7d from line 6c) .

9 Selt- ‘employment tax (from Schedule SE - (Form 1040), line 13).

10 Tax from recomputing prior-year investment credit (attach statement) .

nu Total tax (add lines 8, 9, and 10). Enter here and on line 16c, Form 1040 (make no entries on line 162 _
or 16b, Form 1040) ranean nr woe, 8

te U.S. GOVERNMENT PRINTING OFFICE 1969—-O-337-051


SCHEDULE B
(Form 1040)

Department of the Treasusy
internal Revenue Servics

. Dividends and imterest os
Income Schedule
Attach this schedule to your income tax return, Form 1040

Social Security Number

. Name (as shown on page 1 of Form 1040)

PART !|—Dividends income

_ 1 Gross dividends and other distributions on stock (list payers and amounts—write (H), Ww), (J), for stock
- held by husband, wife, or jointly)

Total line 1

er . eee b 7 ‘
2 Capital gain distributions (see Y ;
page 5 of instructions) . . | .
3 Nontaxable distributions (see | LL
/.

Page 5 of instructions)

4 Total (add lines 2and3). 2. 2 1.) ef _
5 Dividends before exclusion (line 1 less 4—not a

less than zero). Enter here and on Form 1040,
line 12, inspace provided. . . . . 1 2.

PART’ ll—Interest Income (list payers and amounts below)

_ Earnings.from savings and loan associations and credit unions

Enter here and on line 13.


- SCHEDULE A
‘(Form 1040)

Department of the Trossury
Internal Revenuo Service

_ . Name (as shown on Form 1040)

itemized Deductions

Attach this schedule to your income tax return, Form 1040

an:>)
| 1969
Sociol Security Numbor

itemized Deductions—You have a choice between two —

.. deduction ‘methods. You can either itemize your actual
a _ deductions or take a standard deduction. Deductions may be

.. itemized for charitable and other contributions, interest ex-
“pense, medical expense, certain taxes, casualty losses, child
, care, and other items described in the instructions on
’ back. If you take the standard deduction, you will get an

"hospital care, medical insurance premiums, etc.
“. 1 One half ef insurance premiums for medi-
(cal care (but not more than $150) .

. 2 Medicine and drugs .

_ or otherwise) for medicine and drugs, doctors, dentists, nurses,

“amount equal ta 10 percent of the income you report on fine
15c of Form 1040, but not less than $200 plus $100 for.
each exemption claimed on line 10 of Form 1040 (subtract
$100 if married and filing separately). The maximum
standard deduction is $1,000 ($500 if married and filing
separately). If you choose to itemize your deductions, fill
‘ in the appropriate spaces below. ‘

' 3 Enter 1% of tine 15¢, Form 1040 . .
4 Subtract. line 3 from line 2 (not less than
- zere) .

. § ttemize other medical, dental expenses
(Include balance of insurance premiums
_ Not deducted on fine 1) .

required statement). Enter total of
such items here. «6 6) ee |_|

11d Total contributions (add lines Lia,
1lb, and 11c—see instructions for
limitation) . 9... . 0. 0.

Interest expense—Home mortgage .
Instaliment purchases
Other (itemize) -.

. 6 Total (add lines 4 and 5) .

7 Enter 3% of line 15¢, Form 1040: .

8 Subtract fine 7 from line6.0. =. ~=.~«w
9 Total (line 1 plus line 8)... o>
Taxes.—Real estate .

State and local gasoline . .
’ General sales (See page 15 of instructions)

12 Total _interest expense... sO

alimony, union dues, casualty losses, etc.
tL rack
See instructions. - vd g:

.*, State and local income

: Personal property .

"10 Total ‘taxes

structions on back). . . . jf

Ri:
3

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Combined "Department of the Treasury / Internal Revenue Service r
Yoo us individual income Tax x Return a

“For the year January. 1-Devembor 31, L, 1963, or « or other taxable year beginning.
Ce S22 ane 7 PTF
Sawvel ¥ PAVLLLS Raby

i a iG ™ 4a NT & (4) Ee ay. A ves Pv rales

| FRA. wa DA H Lind, cf 4 At eo qi Aft. Your occupation
a | . a if- &y if, ;
“oe . . Spowie! 8 social security umber

_ B99 J iid | thd Jo

Spouse’ $ occupation

ter below. name and address used on your. return for 1968 (if same as above write “Sam”): If none filed, ‘ive | Spouse's
reason. If changing from separate to jgint or joi ‘to, separate’ returns, enter 1963 names and ad resses.,

34n7 VEY ~ G43 AS Ap YE Obi age Hi
Name and address of employer at time cf filing 5 _ :

1] Singie . 41] Unmarried Head pfHousehold
2 EX Married fi filing joint return (even if only one had income) . 6 Surviving widow(er) with dependent child

3 O Married tiling separate return and spouse is ajso filing 2 retura.. 6 (] Married filing ‘separate return and spouse
If this item checked give spouse's sociat secirity number in space provic ad ig not filing a return
above and enter first name hére b>

? ! why!

Check boxes for exemiptions which apply , “Reger ~ '65 or over *. Blind |
. Enter .
ae re number _
cer “Tb Spouse. (applies only if line 2 or line 6 ischeckedy . 5, . | checked > a ‘.
. Hl .§ First names of your dependent children who lived with you~ wo, on le
“g |: FRED -. Berad— Eli sé - Thootas . _! \ Y
RE ee Pam | Ger | le | ame
iv gh DEPENDENTS | (f more space fs neded, wispother side) instructions, 3-2. | income? | write VAL. oo
. Be : : _ ils
" oe : _ i |
"B?
ue co ee ve ee
a

"Please attach Ca:

“Va Dividends a Cabs befors a 7” sail 12b Less Exclusion nem b

exclusion

13 snterest t (Enter total here and if over $100, also list in Schedule B, Part ll)» ce ee

re Other. income: Total from attached schedules (check schedules used—C [1], D ay EO, F DD Sted?
; Adjus!

(Gross
“5b Less Adjustments [rca] $
G8, 20 Scheauie. 7, to figure tax and surénarge. (0 if

Fadd Unes 11, if

15a Tota 12e,.13 & 14.

i as Te ana 17,)

‘ as a | @ Go to Sch. T to: figure ta and surcharge if you itemize ‘deductions; or Glaim ratiremént income Credit, jareign i tax create, or invents
we 5 gi .' ment credit; or if you owe self-employment ‘tax or tax trom recomputing prior year investment credit, Yp gn 3 hy
B: x I- © It neither of above two items applies, go to Tax Tables instead of Sch. T..Complete lines 16, 17,&18. Vee dda
} woe, _ : u
25-5] 16° Tax ‘from Tax Table (see tables on T-2 and T=3). 5 6 a Sp : -Y na LY
' # 5g 17 Tax surcharge on line 16 (see T-1 for tax surcharge tables) . {a 17 .
. > °|.18. Enter total of lines 16 and 17 OR amount trom Schedule T, line

if from Tax Table AC, BE] C (; Tax Rate Sch, (, Sch. D
Total Federal income tax withheld (attach Forms W-2 to back)
“20 -Excess..F.1.C.A. tax withheld (two or more employers—see R-2) ee L
21 ‘gO Nonhighway Federal gasoline tax, Form 4136; [] Reg. Inv., Form 2439

722 ‘ 1969 Estimated tax payments (include 1968 overpayment allawed asa credit) L.
{23 Total odd lines 19, 20, 21, and i, and 22) Soli ees

or Money

st
3
rf S| 24 it ine 1B.is larger than line 23, enter BALANCE DUE. Pay in full with tun —————<p 24
wn |. 4
ri ae
f Sal: a
; = 5 28 If line 23 | is larger than line 18, enter + OVE RPAYMENT - —_ ; oe Ge -
" "| 26. Line 25.to be: (a) Credited on 1970 estimated tax b> $ ; 3 (b) Refunded > $ ; :

e: (a) Grediter po A .
Under penalties of perjury, | dectare that I have examined this reluro,. including accompanying § sehedles and statements, and to" tha ‘best af my wate a it
_ § true, correct, and complete. : oo

4 a e o > Your signature ° _ . Date p> Signature of preparer other than taxpayer, based on Date
4 OD : . all information of which he has any knowledge.

t m=

Ds Spouse's Signature a filing jointly, 80TH list sign ¢ even if f only one had Income) Address hm


' SCHEDULE A

oe 3 Enter 1% of line 15¢, Form 1040, . .

2 line ee

_ 10 Total taxes 2... se 730= | here and on Schedule T, line 2). im] Spon

LOCUS Erno SRR

‘

. i a
‘(Form 1040) |  Remized Deductions
"Department of the Treasury > See instructions on A~l and AW,
internal Revonua Service ; D> tf you use this seheiute, attach f to Ferm 1049,
Name as shown on Form 1 a ” . O) . vo ve Social Beciaty Number .
rans) | we Ss f } iM _ ce : 32a} Jatt | fp mk, j 7 797
Medical and dental expenses (not compensated by insurance Contributions. —Gash—tneluding checks, money orders, etc,
, or otherwise) for medicine and drugs, doctors, dentists, nurses, (Iternize).__
. hospital « Care, insurance premiums for medical care, etc,
2 One halt of insurance premums fer mec:
cal ‘care: (but not more than $150). .
2 Medicine and drugs. . 2's 0 co

4. Subtract line 3 from line 2. Enter differ-

” ence: Cif less than zero, enter zero) .

5 itemize “other medical and dental ax-
", penses (include balance’ of insurance
premiums for medical care not déduicted

Total cash contributions . oo. 4.
12 Gther than cash (see, instructions on
A-1 for required statement). Enter
total for such items here. 2 2.
‘12 «Carryover from prior years (see In- | Lo
structions on A-2) rc . arinlanetsans frome
14 Total contributions | (add lines 1], te _ .
12, and 13—see instructions on A-2. :
for fimitation) . . oe : Hole

Interest expense—Home mortgage toe

, Ty ~~ 4,
installment purchases © 6 6 we oe po -

Other (itemize)

SEE; ie
15 tt otal interest expense 6 =
i, — ads een al

6 ‘Total (add fines 4 and 5).

7 Enter 3% of line 15c, Form 2040 ,

8 Subtract line 7 from fine 6. Enter differ:
ence (if less ‘than zero, enter zero)

9 Total ‘deductible medicat and ‘dental ex-

Naneous “edurtions for child care,
alimony, union dues, casualty losses, etc.
(sze instructions on A+2)__.

1965 jf byioté TAK betekival ted eo

penses (add lines Land 8). 2). Bm im
rrr en nn a i
Taxes,+—Real ‘estate . . ene nn nen ne en
State and focai gasoline. . . . a Lae _ _-

: General: ‘sales (see sales tax tabes) a oe seed cenetarent sneer —~ ef
met neeme 18 Total rile Shaan deductions . =| , as

lines "9, 10, 14, 15, and 16— enter

| Docld:32245535 Page 156 __


SCHEDULE B ‘Dividend amd imterest income §~ “|.”
: . oo BAY
(Form 1040) . f See instructions on B-1 19 6
Titeanl Revenue Service ; D. if you use this schedule, attach it to Form 4040 oe
Name as shown on Form 0 7” ee enn an eee ok Security. Humber
— Samyen Flyenss. Kogyo BRIA 797.
i - PART I-—Dividen d frcome | | ; PART Nae Ankerest Income .
i. Gross dividends and other distributions on stock (ist payers | sociations vadit

i Earnings from savings ard loan associations and credit
and amounts—write (H), (W), Gi). for stock held by fius- unions list payers and armounts) .

band, wife, or jointly)

— Sr tae . x, stu. eo
ae ey 3 ad eee? LaRchet SE :
pee Se ee ee ee a eens enamine ore para st : on :
i
t

4 _ .
da. ; _
: = _ eh » Other interast on tank deposits, bands, LEGS
4 3 i tax i refunds, ete, (ist payers and amounts) yf,
" ~ ere an rn a einen nates me ste Lies
a Lo ‘ ~~ — en
}. a acne
eos ~ —
ay 7 nec ane cesem ene
Boo:
a
ne ent ft a If A RR RR A A IT PP
i . : ae
Hd 1
of wet ~
” _ — oe
th a _ _ _— pene ence een Lae. a a . _.
Vea po OS a
ines i = — a — oe — ee meen fence fers gene tnt se re —
F ° : . — rence ee ene eeeY ee -
Booed . es ee oe a ae
", ht 2 Total of line 1-. 1... 2 we
at ty 3 Capital gain distri- |
Boot, butions (see instruc- |
mo fee tions on B~1) . ee
4 , t 4 Nontaxable distribu- |
% was tions .(see instruc-
hy tionsonB-1). . . | en tmnnner nn pene
. gt Total 1 ted lines 3 and 4)...
. 6 ‘Dividends before exclusion (sulstract | 7 - ans ns hi
: . "fine 5 from line 2). Enter here and on | 3 Total interest Income. Enter here and
ioe not . . 4 ak | é —_
| form 1040, tine 108 __o8 Form 2040, Hine Uh : a MOST. Lee
sey , :
7


SCHEDULE D Sales or Exchanges of Property
(Form 1040) pb See instructions on D-2 and O—2. ,

Department of the Treasury | B+ Sf you use this schedule, attach it to Form 1940.
_dnternal Revenue Service

h Fi aoc. | fi “Tt ee , Social Security Sap
Name as shown on Form SAMUEL + fyeers Key Bad JZ 7

ae enn iedy

Part I-—CAPITAL ASSETS—Short- tert capital gains and losse rete heid net more than 6 months
need een women _ canes: maleate

{ c. How r ee ne

Kind of 1 ac: . ne Cost or other

a, Kind of prop- -b, Description Quired, asis, cost :

erty. indicate (Examples: ‘90 she a “Enter & Rate e. Bate sald | f. Grosg sales | * peered cigtion sabsoqusnt,mpiove i. Gain or loss
, “we acquired ore Be a sani @

estate,’ or other a Ca "dep " symntat | (ra9., day, (yr) fma., say, 91.) purchased, attich (F plas g‘less h)
(Specify) . explanation) and

+ &xpense of sale

anne ge a bee eee eek

2 Enter-your share of net short-term gain (or joss) frern part ’nerships and fiduciaries

3 Enter unused short-term capital loss carryover from. preceding $ taxabie years {attach statement)
4 Net short-term gain (or loss) frorn lines 1, 2 2, ar and 3

Se

. 5 Enter gain from Part th line 3

. Ga Enter your share of net long-term gain (or loss) from partnerships and fiduciaries. =... .

6b Enter: your Share of net long-term gain from smail business corporations (Subchapter S) .

7 Enter unused long-term, capita! loss carryover from preceding taxable years (attach statement)
8 Capital gain ‘dividends veo Se ee ee
9 Net long-term gain (or loss) from lines 5, 6a, 6b, 7, and 8. ee
10 Combine the amounts shown ori lines 4 and 9, and enter the net gain. (cr ios) here . ee
11 IF LINE 10 SHOWS A GAIN—Enter 50% of line 9 or 50% of line 10, whichever is smailer. (Enter zero if thera is a loss |.

or ne entry on line 9.) (See reverse side for computation of. alternative tan). 2 ew we eh ,
12° “Subtract: line 11 from line 10. Enter here and in Part IV, line 1, on reverse side .

13 IF LINE 10 SHOWS A LOSS—Enter here anc in Part IV, fine 1, the smallest of: (a) line 10;

Forni 1040, if tax table used) computed without capital gains or losses; or (c) $1,000... al . 8
es ttre

‘Part I—GAIN FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SEC MONS 1245 AND 1250—
assets held more than 6 months (see instructions on D~1 for definitions)
‘Where ‘double headings appear, use the first heading jor sectlon 1245 and the second heading for section 1250.

nation) and expanse of sale

! oe

. Kind, of property and how acquired (if necessary, attach statement . . . e. Cost or othey basis, cost of
of descriptive deisils not shown balow—write 1245 or 1250 b. Date acquired m. Date sold d, Gross sales price “subsequent improvomants (if
to indicate type of asset) (mo., day, yz). Gags, day, yn) fot purchased,’ dtiach 2xpla-

i. Ordinary gain a

f-L, Prior to January 1, “1962 iva ‘Alter December a1 136! 1 8. Adjusted basis h, Total vain (lesser of f-2 or bh)
~~ = OR == [2:2 Alte Os OR--—=-——=-4 (a tess sum of fl and f-2) |. dese UR emem wm nee “i iteasn
Priaz to January 1, 1964 | Afler December 31, 1963 : ae instructions) 1

2 Total ordinary gain. Enter here and in Part lV, tine 2, on reverse side .

7 a : . . we 1 .
3 Total other gain, Enter here and in Part |, tine 5; however, if tha gains do not exceed the josses when this emount is

combined’ with other gains and fosses from section 123) property enter the total of column j in Part Ul, line 1. 2°
en oem nla

“NWW-88326 Docld:32245535 Page 158 - a


OR Ds ac al blk AO

ORE awe
poo no . . , : _ }
ULE TS PO , Pent : , Che oe
1040) oe Tax Computation 1969 =
ofthe Treasuy | Bb If ao entry is made on line 14, line 16, or line 17, keep this for your records : YW) Nosy ey, \ded h
‘enue Service “4g . : . : . . : ded by the
b> If entry is made on line 14, line 16, or fine 17, attach to form 1040 ons. This is
- - “s ; 12 opm ene ce - as arT ean enna tule T. Also
shown on Form 1040 ° WA so Social Security Number : :
" : : : t . , :
SAMUEL PuYeLis vu BY 222} / Al 777 \
adjusted gross income (from line 15c, Form 1040). -° + 8 ee et ge ee bee rm
iif your adjusted gross income is less than $5,000 and you cheose to take the standard deduction ee
fad of itemizing your deductions, omit lines 2, 3, 4, and 5. Find your tax in the appropriate table 7
r.B on 1-2 or C on T-3), Enter tax on line 6 below. ‘ ie ormare.
onthe. line. at the right the amount of your deduction figured: under one of the following + [there isnotax,
j , RT ns . : “Wini-
you itemize deductions, enter the total from Schedule A, line 17 —
OR. oO i =
gure your standard deduction as follows: , ; 5 6)
(1). Enter 10 percent of fing 1 but do not ) o
-" ‘enter. more than $1,000 ($500 if - . ) - 0
«married and filing separately): .- $ Enter th larger of bat) 2 9
(2) Enter the sum. of: $200 ($100 if j right. If your spouse files 3 O.
_ married and filing separately) plus . a separate return, deter- 5 3
$100 for each exemption claimed in . mine your deduction in ) 0
line 10 of Form'1040, but do not __— : the. sama manner that 3 Oo -
eriter, more than $1,000 ($500 if : , she (he) has. . i») i 9 .
married and filing: separately) 8 $ : 7 9
rn me aa a : 3 oO
tract the amount on line 2 from the amount cn line 1 and enter the balance here, 5 8 6 eo emer entme se) 0 :
ér number of exemptions claimed on line 10, Form 1040, ....u.. ... Multiply this number by $600, and g 9 \
er the amount here a eon ee 9 8
stract’ the amount on'line 4 from the amount on line 3 and enter the balance here. This is your 3 5
able. income. Figure tax on this amount by using the appropriate Tex Rate Schedule (1, H, or HA on Q 9
- Enter ‘tax an ine 6 below. . - + + + ee i) o ,
a rr ee eer : 9 Q ;
‘ou-claim the retirement income credit, enter amount from Schedule R, line 12,here s 6 6 8 0 6 be ; of g ‘
tract line 7 fromline6 2 pe ee 2 ee eh et ce ee pe ee eee :
phen 7 Co _ : ‘of Qf 8 :
¢ surcharge. If line 8 is less than $735, find surcharge from tax surcharge tables on T—1. If line 8 Is 8 g 5 : “
35 or. more, multiply amount on line 8 by .10 and enter result here 2 6 6 ee De of oo OO \
cette | 7 po ag) 8 |
eg - oo . . of of. 0 4
tal (Add lines 6 and 9) eo 8 © © 7% 6 ® © © © 8 F 8 F -e@' 8 08 8 Oo 8 | 8 8 ( °
it 7 . . oo i en eee i
. siek, mo, . : . : vel ay 0
irement income credit from Schedule R, line 17 (attach Schedule RY. 6 2 6 + og
: - 0

vestment credit (attach Form B48). . ee ee
reign tax credit (attach Form 1116). + + + + * ss 6 * rr

o900)] O00
LOL aa
sbeoloo
|
5| coo!

, oe os oa S| ee .
| eiaits (add lines 11,12, and 13)'6e 2 ee ee ee ee ee bet
- re . : Oo og 8
come tax (subtract line 14 from line 10). 2 2 0 © 2 ee oo ee wwe ee | eects unewene en |= 7 !
i: . eo Sd namecere i
wh : . of Oo) . 2 :
ai . ; . gt | ron fv) a ee) o
alf-employment tax (attach ScheduleSE) - 2 2 + se sf es Fe 8 2 2 0 oe oe poe 9 9 Q
vee ye  tnvae . : QO |— af of 9
ax from recomputing .prior-year-investment credit (attach Form 703) orca an 3 Qh. 9
otal taxr(add lines 15, 16, and 17). Enter here and on line 18, Form 1040 (make no entry on line 16 ey Nee 3 oe
17, Form 1040). Attach Sch. T to Form 1040 only if you made an entry on line 14,16, or 1/7 abova. . © |r : tg
eee ae Ee eee ae een mn ene a 6
te ‘Averaging.—-If your income has ° (b) a joint return, or as a surviving fus- To claim tax-free covenant bonds credit, go 6
ased substantially this year, it may .band or wife, with taxable mcome @x- enter: the amount of credit above line od
‘your advantage to figure your tax ceeding $52,000, or (c) as a head of 14, and write “covenant bonds’’ to left Go 60
@ surcharge under the “averaging household with taxable income exceeding of the entry. : . 9 0
od.”, Obtain Schedule G from an $38,000, ; : a) 4
aal Revenue Service office for full |. . Line 16-~Self-Employment Tax.—Enter ape
IS bs — a Line 9—-Tax Surcharge.—The rate for amount shown on fine 9, Part tll, Schedule sa te
Pe eB . the calendar year 1969 is 10 percent, SE. S61 25
natives Tax.—It will “usually be to The tax surcharge is an addition to the a3| 32 ,
advantage to use the alternative tax reguiar income tax. See the Tax Sure. Line 17--Tax From Recomputing Prior ° in 39
in-net long-term capital -gain exceeds charge Tables on T~1. . Year Investment Credit.—Enter the '
net short-term. capital oss, .or if you arnount by which the credit taken in a ee i
a net long-term capital gain‘only, and = Credit for Foreign Yaxes and Tax-Free = prior year or years exceeds the credit as . T-3 of

are filing (a) a separate return with Covenant Bonds.—You may claim these recomputed due to early disposition of |
ale .income exceeding '$26,000, or credits only if you itemize deductions. property. Attach Form 4255. : v4

nn | _ |
WW. 88326. Docid32245535 Page 159



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896! IASHELES YL OH HE


ea STE SE ee SER MEME TRATES ° PORTER a

Ua 3 ® K RA iG ti as barre Ss. es Internal Revenue Service SiN t: 0)
. LY,

i Q Cc ® m e. Ta. x R e t u r i for the year January 1~December 31, 1968,

aeesevesee seneaseeeentenceraneee , 1968, ONGING ....ceeveseeesscensesoronsees LO cesceee
First namo ond tnitiol (If joint return, use first names and middie initiats of both) Last name Your social security number

Rube |

3221 2| 7% 97

Your wre

PLO ¢ aa

Spouse! 3 social wa numb

Shoup’ 3 conupation
/ CUS Gt f

"ZIP. coda

Enter below namé and address used on your return for 1967 (if same as above, write “Same”'). If none filed, give
reason. If changing from separate to joint or foint to separate returns, enter 1967 names and addresses.

c

Your Filing Status—check only one: Your Exemptions Regular 65orover Blind

Ja Single - 2a Yourself. . . Of O °° QO jrumber
‘1b (Q. Married filing Joint return (even ifenly ane had income) | 2b Spouse ... a7) oO Cf checked 2.
4c O Married- filing separately. If spouse is also filing a return, | 3a First names, of your dependent children who lived’ with: _

7 enter her (his) social security number in space provided above you Fr oo . ;
2 and give first name hera__ a esis thor > AF .
\ ‘ld O Unmarried. Head of Household 3b Number of ‘ther dependents (from page 2, Part |, line 3) '
“le oO Surviving widow(er) with dependent child 4 Total exemptions claimed . . . . . OLB CG
: Income | 5 Wages, salaries, tips, etc. _If not shown on attached Forms W-2 attach explanation |5 & 250) 20
a Uf Joint re 6 __ Other income (from page 2, Part li, line 8) 6 | OGIO
’ * & allincoma 7 Total (add lines 5 and 6) ; Z| OS //9 “Oo
ay of both EE Adjustments to income (from page 2, Part Ill, line 5) 8 ‘ on bs 2s
a : and wife 9 __-Total income (‘‘adjusted gross income’) (subtract line 8 from line 7) 9 } 3
a 4B Find tax. 10° If you do not itemize deductions and line 9 is under $5,000, find tax in tables on oD
: uw from table pages 12~14 of instructions. Omit lines 11a, b, c, or d. Enter tax on line 12a, |20 oo
5 —OR— eh hills

lla- If you itemize deductions, enter total from page 2, Part lV, line 17
“If you do not itemize deductions, and line 9 is $5, 000 or more enter the larger of: jiu 7
(1) 10 percent of line9; OR (2) $200 ($100 if married and filing separate return) lla a

"plus $100 for each exemption claimed on fine 4, above. _
‘Deduction under (2) or (2) limited to $1, 000 ($500 if married and filing separately).

25 Subtract line 24 from 23. Apply to: (1) U.S. Savings Bonds, with excess refunded or [1] Refund only |25 ~

“Under penalties of perjury, 1 doclaro that | hava examined this return, Including accompanying schedules and statements, and to the best of my knowledge ond beliof it le
trus, corroct, and completo. If proposed by o porson othor than taxpayor, his declaration is bared on ali Information af which he hos any knowledga,

1b’ Subtract line 11a from lire 9. Enter balance on this line wp] 6 -663/37 my
lic: Multiply total number of exemptions on line 4, above, by $600 7 ‘Ve 2 ans ‘f
ad lid Subtract line 11¢ from line 11b. Enter balance on this line. igure your tax on this |43g
7 , . : ‘., amount by using tax rate schedule on page 11 of instructions.) Enter tax on line 12a. 2 Ob: 2 BL
gto 12a Tax (Check if from: Tax Table (J, Tax Rate Schedule i, ‘Sch. D 4, or Sch. G (1) ‘Tal ao OZ.
, 42b Tax surcharge. tf line 12a is less than $734, find surcharge from tables on page 10 of instruc- :
: tions. if line 12a is $734 or more, multiply amount on line 12a by .075 and enter result. (If |12b - .
, you claim retirement income credit, use Schedule B (Form 1040) to figure surcharge.) . 2. af Ci)
tL. 12c Total (add lines 12a and 12b) __(t2e T&elSY
me 13-. Total credits (from page 2, Part V, line 4) . 13 | // oy
= ee 14a Income tax (subtract tine 13 from line 12c) : 14a Sf? oy
E tax 14b Tax from recomputing prior year investment credit (attach statement) . 4b _
7 = Credits 15 Self-employment tax (Schedule C3 or F-1) 15 _ .
“B and |26__Total tax (add lines 14a, 14b, and 15) 16 “A DANOG
7 ° Pay-. 17. Total Federal income tax withheld (attach Forms W-2) 17 LST OO Mane “cneew on Y
' g ments 18 __ Excess F.1.C.A, tax withheld (two or more employers—see page 5 of instr.) 13) Z money order pay- Z
= : 19 E] Nonhighway Federal gasoline tax—Form 4136, [] Reg. Inv.—Form 2439/19] CS Z ante ate ginternal y
5 20 © 1968 Estimated tax payments (include 1967 overpayment allawed a asa credit) 20| Cy memmmnnmnnnannnids
8 21.. Total (add lines 17, 18,19, and 20) oe ; : 21 | 3h BI OO
6S 22 if payments (line 21) ara less than tax (line 16), enter Balance Due. Pay in full with this return 22 "4 Ve,
i s Balance 23 __If payments (line 21) are larger than tax (line 16), enter Overpayment ; 23 | __
_& Refund |24 Amount of line 23 you wish credited to 1969 Estimated Tax [24 tT

Your lature . . Dato Ds Signature of proparer othor than taxpayor
ae at Fling felntly, wort mueat igi oven if TT ‘oho hed Incomo) Address 089-1680. 1898


Dee ieee oat ead ee

4 Exemptions
aL
(a) NAME (if more space is needed attach schedule)

on

1
2

la Gross dividends and other distributions on stock (list payers
and amaunts—write (H), (W), (J), for stock held by husband, wife, or
pintly)

Total Jine ‘da

: ib Exclusion (see instructions).

+e Capita! gain distributions

(see page 5 of instructions).

- Ad Nontaxable distributions
' (see page 5 of instructions).

[ £C0l6Q

le Total (addtines1b,1c,andid). . « «
Taxable dividends (ine b la less line le—
: _ not less than. zero) oor ee
Re -

> *_ Interest (list payers and amounts below)
'"- Earnings from savings and loan assoc. and credit unions.

if

Completa sniy for dependenis claimedon line 3, page i
(b) Relationship (c) W Months tived Pe

bor od
my oar write “B" or "D"

“poe ~ alse 2

_ | Other interestfon ban
yo Lew.On) k

2 Total interest income

oe ne
3: Pensions and. annuities, rents and royalties, part-
. nerships, astates or trusts, etc. (attach Sch. B) .

. 4 Business income or loss (attach Schedule C) .
5 Sale or exchangé of property (attach Schedula D) .
" .6 Farm income or loss (attach Schedule F).

'*” Miscellaneous income (state nature and source) ..:
* pith At C88... OUI
Ola. Cane WEAN Ona l

: 9 Total miscellaneous inéome .

“8 TOTAL (add lines 1f, 2, 3, 4, 5, 6, and.7).
* Enterhere and onpagel,line6. . . >

artalit® Adjustments to income . ob

“4 "Sick pay"’ if included in line 5, page 1 (at:
tach Form 2440 or other required statement) .

° 2 Meving ¢ expenses (attach,Form 3903). .

: 3 E Eniplosee-buamess SxfenseGttecr-Form |
, 2106-or other statetient) . toe

6 Payments by self-amployed persons to re-
tlrament plans, ‘ete. (attach Form 2950SE) »

a 4

13 Totai contributions (add lines 10, 11, ,
-— and i2—see instructions for limitation) >

Bl 7st cS)
|
S869 YO)

* B TOTAL ADJUSTMENTS (lines 1 through 4),
Enter here and on 1 page | 1, line: 8 a

Uo

irre ty U.S. GOVERNMENT PRINTING OFFICE 1 1e80—--290-001

i

Form 1010—1968--Paga &

(a) Amount YOU furnished
for dependent’s Aiport
100% write “ALL!

(d) Did depena-
ant have income
of $600 oF more?

(f) Amount furnished ©
by OTHERS includ- ~
_ ing dependent. -

id dur-

+

wi Itemized deductionscuse only if you do notuse
tax table or standard deduction.

Medical and dental expense (not compensated by insurance or

otherwise)—Attach itemized list.

1 One-half of insurance premiums for medi-
cal care (but not more than $150) .

-|2 Total cost of medicine and drugs . . .

3 Enter 1% of line 9, pagel . . . . . ——

4 Subtract line 3 from line 2 (not fess than zero) ;

5 Other medical, dental expenses (include :
balance of insurance premiums for medi- .
cal care not deductible. on line1) . . . —

6 Total (add lines 4 and 5) re ie —

7 Enter 3% of line 9, page ; :

8 Subtract line 7 from line 6 (not less than- zero) ;

9 Total (add lines 1 and 8).
0 checks,
1/ eam .

money . orders, ete.

10 Total cash contributions . . 1 »

11 Other than cash (sea instructions for required
statement). Enter total of such items here.

12 Carryover from prior years (seo page 7 of instr.)

Taxes.—Real estate... _ coe eh
State and locai gasoline . toe : ' :
General sales (see page 15 of instructions) .
State and local income. « . » « «
Personal property... « « ee

14 Total taxes . oe ee ee
Interest expense.—Home Mortgage. « .

Instaliment purchases . . . « « 2 4
Other (itemize)

16‘Total miscellaneous... . . .

17 TOTAL DEDUCTIONS (add lines 9, 13, 14,
_ 15, and 16). Enter here and on page 1, line lla.

az Wd Credits | |
1 Retirement income credit (Schedule B) .
p* TZ 7 (ok

2 Investment credit (Form 3468). .
Wisy

3 Foreign tax credit (Form 1116); . . .

44 TOTAL CREDITS (for page 1, line 13) .

EXPENSE ACCOUNTS—if you had an expense a anes or Charge
‘expanses to your employer, check here [) and aga 6 of Instruction

oh 16—8O1d09] *

~

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- Long-term capital gains and losses—assets held more than 6 months (12 months or more for certain livestock)

. 13 If line 10 shows a LOSS—Enter here and in Part iV, line 1, the smallest of the following: (a) the amount on line 10; (b)

Sigmar = . II LT TO EG TE

'

Gains and Losses From Sales ¢ or r Exchanges
of Property

Attach this schedule to your income tax return, Form 1040

' SCHEDULE D
(Form 1040)

U.S, Treasury Department
Internal Revenue Service

Name as shown on page 1 of Form 1040

Biro |

‘zdins and losses—assets héld not more than ‘6 months

Social ais Numiber

72 | 2LG2

a. Kind of : . = Hom : he Cost or other
. Kind of prop: b. Description quired : asis, cost o
Sreiege vest | Sgummplet, 100 sof | Ener’ | $Date ato sold | f. Gros ant | © ,poprritin | subsoqunt imorove-
os ae fe 7 ON | sig [mon eer aea rom) wees ae nee | pacha ac
. : : et
. . woes instr.) |: expense of sale
_—_—_——— -
i

<a ss CAs

Lah 2

2 Enter your ‘share of net short-term gain (or loss) from partnerships and fiduciaries ». 1 6. ate ew ek et
3 Enter unused short-term capital loss carryover from preceding taxable years (attach statement). .. | .:
‘4 Net short-term gain (or loss) from lines 1,2, and 3... 2. a a)

5 Enter gain from Part Ii, line 3. a

6a Enter your share of net long-term gain (or loss) from partnerships and fiduciaries... . 1 tte : ee © ew
6b Enter your share of net long-term gain from small business corporations (Subchapter S$). . ; ee ee soe od
7 Enter unused long-term capital loss carryover from preceding taxable years (attach statement) . :
8 Capital gain dividends (see Form 1040 Instructions, page 5). 2. 6 6 ew ee ke we te ke elt
9 Net long-term gain (or loss) from lines 5, 6a, 6b, 7, and 8. 1. 1 ww Sw ee ee ee we eee

10 Combine the amounts shown on lines 4 and 9, and enter the net gain (or loss) here. «1's 4 1 6 oe we
11 H line 10 shows a GAIN—Enter 50% of line 9 or 50% of line 10, whichever is smaller. (Enter zero if there is a loss or no

entry on line 9.) (See reverse side for computation of alternative tax). 0.0. 6 ee we ee te
12 Subtract line 11 from line 10. Enter hera and in Part iV, line 1, on reverse side. . 1. 1 ew te ek le

the amount on Form 1040, page 1, line‘11b, computed without regard to capital gains or Josses; or (c) $1,000. . . ©

. Part II—-GAIN .FROM DISPOSITION OF -DEPRECIABLE PROPERTY. UNDER SECTIONS 1245 AND 1250—
- assets held more than 6 months (see instructions for definitions)
Where double headings appear, use the first heading for section 1245 and the second heading for section 1250.

a. Kind of property and how acquired (if necessary, attach statement
of descriptive details not shown below—write 1245 or 1250

d, Gross sales price
_ to Indicate type of asset)

b. Date acquired
(mo., day, yt.)

¢, Date sold
<mo., day, yr.)

f. Depreciation allowed (or allowable) since acquisition’

- f, Ordinary gain
fh i. Prior to January 1, 1962 | f-2. After Decom ber 31, 1961

h. Total gain (lesser. of -2 oF bh)

g. Adjusted basis -
Cd less g)

(8 less sun of f-l and fH 22)

After December 31, 1963

Prior to Tonuery 1, 1964 (see instructions)

$$]

2 Total ordinary gain. Enter here and in Part IV, line 2, on reverse side rrr)
3 Total other gain... Enter here and in Part |, line 5; however, if the gains do not exceed the losses when this amount is.
_combined with other gains and losses from section 1231 property enter the total of column j in Part IH, jine i.

saatececnnerescnnnnnnc|nen tay

1, Gain or loss
(f plus g less h)

@, Cost or other basis, cost of
subsequent improvements (if
not purchased, attach expla-
nation) and expensa ot sale

~ f. Other ain
he loss) .

SEITE: Sela 2 ARETE: Page 16 Loewe Te

r= Re MBA

Date ante es Pees ‘ to sek, tance eee

FED

a | '
at 1

ve |

U.S. Individual U.s. Teds .
A neome Ta A Be e ace t oe yel i Tanuaty oem 31, 1967,

1967, ending ,19.....

_ ed sRugternal Revenue Service
|

. or other taxable year beginning .....:-.
_ First nario and Initial (If joint return, use first names and middle initials of both)

Last ‘namo Your social security number —

Bao y2i2ge7

. Your occupation oo
Epgince’ —

ZIP code Spousg!) fsociol security number
BYGIIESVIO.

Spouse's occupation

5 Samucl_and Phyllis

E Home addrass (Number and streot or rural Toute)

a . A nes

City, tawn or post office, and/State

Piease pri

Enter below nam nd address used on your return for 1966 (if same as above, write *Same’’). | If none filed, give reason. if changing
from saparate to joint or joint to separate returns, enter 1966 names and addresses.

Your Filing Status—check only one: Your Exemptions Regular 65orover “Blind enter
. . -]

la ©). Single , 2a Yourself . . « O o jarease
: . . : of boxes [oa --
Ib Married filing joint return (even if only one had income) | 2b Spouse . + + -0O OC . J checked | 224.
1c 0) Married filing separately. If spouse is also filing @ ietura, | 3a First hames of your dependent children who lived with}
7 °° enter Her (his) social security number in side provided above you':. posal QLOLG LD sjacesneetoven ;
. and give tlrst name here : sectessectens wo hh Se ec GMMAEcrervesscaresaneeees
id ( Unmarried Head of Household 3b Number of other dependents (from page 2, Part 4, line 3)

Ye O Surviving widow(er) with dependent child 4 Total exemptions claimed _.

oO Be euch ctiem ow:
Signature of preparer othor-

bye 27
|Z LM dishes

3 income 5 Wages, salaries, tips, etc. If not shown on attached Forms W-2 attach explanation |5_
x Hane 6 Other income (from page 2, Part Il, line 8) 6
& all income |_7 Total (add lines 5 and 6) 7
3 of Bath | 8 Adjustments to income (from page 2, Part Ill, line 5) 8
’ ' = and wife “g Total income (subtract line 8 from line 7) : 9
a 2 Find tax 10 Iftyou do not itemize deductions and line 9 is less than $5,000, find your tax from 10 :
‘5 from table tables in instructions. Do not use lines lla,'b,.c, ord. Enter tax on line 12, :
2 — : *
2 lla If you itemize deductions, enter total from page 2, Part lV, line 17 : me,
eB \f' you do not itemize deductions, and line 9 is $5,000 or more enter the larger of: / Ee 2 f a
o (1) 10 percent of line 9; OR (2) $200 ($100 if married and filing separate return) lial, ; :
ae Joo pius $100 for each exemption claimed on line 4, above. Y
[3 . +
Ss ean Deduction under (1) or (2) limited to $1,000 ($500 if married and filing separately). Yyy
~~ iT fe
a 7 a 7
rata b hi 1 i “ Brelm . :
2 Tats lib Su tract ine 11a from line 9 _ eve, SOB ;
8 lle Multiply total number of exemptions on line 4, above, by $600 3 & fol} (6) fe) me
a "| 21d Subtract line.1ic from ling lib. Enter balance on this line. (Figure your tax on this :
von be amount by Using tax rate schedule on page 11 of instructions.) Enter tax on line 12.
- “ - - are + = _—— _ = a —————.
. 12 Tax (from either Tax Table, see line 10, or Tax Rate Schedule, see lines Lla=11d) _
: 13 Total credits (from page 2, Part V, line 4) ; . oe
_Your 14a Income tax (subtract line 13 from line 12) .
Tax 14b Tax from recomputing prior year investment credit (attach, statement)
i Credits 15 Self-employment tax (Schedule C-3 or F=1)
: wand ee et?! tex (add lines 14a, 14b, and 15). ;
2 Pay. 17 Total Federal income tax withheld (attach Forms W--2)
5 men ts 18 Excess F.I.C.A. tax withheld (two or more employers—see page 5 of instr.)
6. 19 (J Nonhighway Federal gasoline tax—Form 4136, (3 Reg. lnv.—Form 2439 ) 19.
2 1967 Estimated tax payments (include 1966 overpayment allowed as a credit)
& Total (add lines 17, 18, 19, and 20)
5 Balance “32 Mf payments (line 21) ate less than tax (line 16); enter Balance Due. Pay in full with this return
3 Due or 23 If payments (line 21) are Jarger than tax (line 16), enter Overpayment -
& Refund “24 Amount of line 23 you wish credited to 1968 Estimated Tax
£ 25 Subtract line 24 from 23. Apply to: (1) U.S. Savings Bonds, with excess retunded or
8 Under penalties of porjury, | declare that |’ have examined this return, Including, accompanying schedules and statemdnts, and to ‘the best of my knowledgo and bolief It Is
Nas cérréct; and complete, If prepared by a person other then taxpayer, his declaration is based on all Information of which he hes any Wena ff, Va

‘Sign p
here 6

cpay oF
7 eV Se
ote Kistie Mr ke Kecow en Set iain hos

6301

Please.

went oe ce ter ce


+
?

| SCHEDULE. > | Gains and Losses From Sales or Exchanges
(Form 1040) | of Property

Us, Treasury Department
Internal Revenue Service Attach this schedule to your income tax return, Form 1040

Hi
2 a. Kind of ° on . . Fe Cost or ather
Ad Of Prop. b. Description quired. asis, cost o!
arty. Indicate (Examples: 100 sh. of Enter d. Date 2. Dat g. Depreciation | subsequent improve-

; : . ; 6 sold ft, Gross sales . 4, Gain of loss
ecacurity, reat "2" Ga, 2 story brick, deter, (magi se) {mo., doy, ye) |”, price as Shee purchased attach (t plus g less h)

a “ (Specify) vf: etc.) (See . . ‘ acquisition . explanation) and

a instr.) . . expense of sale

VELY,

| L227.

“2 Enter your share of net short-term gain (or loss) from partnerships and fiduciaries .
3 Enter unused: short. term capita! loss carryover from. preceding taxable years (attach. statement) . eee ew
= 4 Net short-term gain ‘(or less), fiom lines 1, 2) and 3. Se ee ee ee ee Loa . toes .

oo! * Long-term capital gains and losses—assets held rnore than 6 months (12 months or more for certain livestock)

5 Enter gain from Part It, line 3. . .

oh ee 5; pSiteed.| Ly

Total long-term gross sales price ,

Enter the full amount of your share of net long-term gain (or loss) from partnerships and fiduciaries. . . . + »|/-
Enter unused long-term capital loss carryover from preceding. taxable years (attach statement). 2. . 2 2 6 « :
Capital gain dividends (see Form 1040 Instructions, page6) - . - +» + + : er er?
Net long-term: gain (or loss) from lines 5,6,7, and8. ‘

wanna

10 Combine the- amounts shown on lines 4 and 9, and enter the net gain (orloss) here. we we ee
11 If line 10 shows a GAIN—Enter 50% of line 9 or 50% of line 10, whichever is smaller. (Enter zero if there is a Joss or no

entry on line'9.) (See reverse side ‘for computation of alternative tax)... 2 eee ee ee es ee -
12 Subtract line 11 from line 10. Enter here and In Part IV, line ‘Ly! on reverse sida, 6 se 6 eee ee .

13 Mf line 10 shows a Loss—enter here and in Part IV, line 1, the smallest of the. iallowing: (a) the amount on line 10; (b)
the amount on,page 1, line 11b, Form 1040, computed without regard.to capital gains and losses; or (c)- $1,000. . «

Part IH—GAIN-FROM DISPOSITION OF DEPRECIABLE PROPERTY UNDER SECTIONS 1245 AND 1250-—~

assets held more than 6 months (see instructions for definitions)
Where double headings appear, use the first heading for section 1245 and the second heading for section 1250.

b. Date acquired c, Date sold 3 ft ra ine basis. cost of

~b. . d 7 subsequent improvements (if

(ine., day, yr.) (mo., day, yr.) Gross sales price not purchased, attach orate
q nation) and expense of sale

a. Kind of property and how acquired (if necessary, attach statement
of descriptive details not shown below—write 1245 of 1250 ~
to indicate type of asset)

f. Depreciation allowed (or allowable) since acquisition
. |. Ordinary gain

— | g Adjusted basis h. Total gain. lesser of f-2 or hi i
Th, Prior to January 1, 1962 | f-2. After December 31, 1961 | (o/oss sum of f-1 and f-2) (d tess 8) Messer oft zor ny Je einer gain
ee OR gga | Miler Doce ---- . Gee instructions)

- 2 Total ordinary gain. ‘ Enter here and in Part IV, line 2, on reverse side. . « . 2. 28

_ 3 Total other gain. Enter here and in Part J, line 5; however, if the gains do not exceed the losses when this amount Is
«++ combined with. other gains and losses from section 1231 property enter the tatal of column j in Part it, lina 1. . ,
7 — Hi . W—79725-1

SG)


mem ny

fn Tacome from courcesother thanwages, etc.

1b Exclusion (see instructions).

1, le Capital ‘gain distributions

"Interest (list payers and amounts below)

oom 2 Total interest income .

. 5 Sale or exctiange of property (attach Schadule D) .

soe . Miscellaneous income (state nature and source) ..

* g TOTAL (add lines 1f, 2, 3, 4, 5, 6, and ne

(d) Did depona-
ent bave Income
of $500 or more?

fe). Amount YOU Tonished
for depandent’s support,
it 100% write “AL

<P Amount furnished’ .

® Relationship i 5 Noninslived in your
7 by OTHERS ine includ.

home. If born o¢ died dur-
Ing yoar wilte * “BY or “D"

‘J TTiemized deductions—Use only If you donotuse

“tax table or standard deduction,

la. Gross dividends and other distributions on stock (list payers | Medical and dental expense (not compensated by insurance or
and amounts-—write (H), (W), W), for stock held by husband, ‘wife, ‘or | othernvise)—Attach itemized list.

1 One-half (but not more than $150) of ine
surance premiums for medical care. .

Total cost of medicine and drugs . « -
Enter 1% of line 9, page 1

Subtract tine 3 from line 2 (not less than zero)
Other medical, dental expenses (include
balance of insurance premiums for medi-
cal care not deductible online 1) . . .
Total (add lines 4.and5) . .
Enter 3% of line 9, pagel... + e
Subtract line 7 from fine 6 (not less than zero) .
Total (add lines 1 and 8) . ;

Total line Ja

(see page 6 of instructions).

Jd Nontaxable distributions |
(see page 6.of instructions). |____—__—-a-= | ae

le Total (add. ‘lines 1b, 1c, and 1d).
lf Taxable dividends {ine * la less line le—-
not less than zero) ad

Earnings from savings and loan assoc. and credit unions.

10 Total cash contributions 2... 1 + 6 |iscesneeeeees
~142 Other than cash (see instructions for required.
. statement). Enter total of such items here
{12 ‘Carryover from prior years (soo page 8 of Instr.)

+] 13, ‘Total contributions (add lines 10, 11,
and 12—see instructions for limitation) >

Other interest & nks, bone tax refunds, etc.)
Ast Aatl te. a.nd. 20 giseel,

cesceessseseerscsnenese - Taxes.— Real estate. 2 «ee

“State and_jocai gasoline . .: « th.
General ‘eatdg {soa page 15 of Instructions).
State and local income. . . 6 6's

3 Pensions and annuitics, rents and royalties, pat

Personal rope
nerships, estatos or trusts, etc. (attach Sch. B) . rs property

14 Total taxes. we ee ee
Interest oxpense.—Home Mortgage :
‘Other (itemize
‘Be yt. al ia
Freeh bags
ALS Gm .

15 Total interest expense

4 Business Income or loss (attach Schedule c).

dula F) .

6 Farm incoma or loss (attach Sche

float ee

7 Total miscellaneous Income... P —— | Misc Hangous deductions. .— (sea page 9 of Instructions) ..........-- :
Ss

aok..ces

Enter here and on page 1, line 6. .
7 a Yy !
Te |

Teal] Adjustments to income a A ee ee

i wick pay’, if included in ine 5 pagel (at | 17 TOTAL DEDUCTIONS (add lings @, 13, 14,
; Ent d >
2 Moving expenses (attach Form 3903) . 1, and 16). Enter hore and on page 1, tine lla.
7] Credits

tirement income credit (Schedule B) .

3 Employee business expense (attach Form

2106 or other statement) . 1 1 + « Jacesssesnerene: seeneefeescee i
4 Payments by self-employed persons to re- 2 Investment credit (Form 3468). - +
tirement plans, etc. (attach Form 2950SE) . 13 Foreign tax credit (Form 1116)... - —_
——|.4 TOTAL CREDITS (for page 1, line 13). >
5 TOTAL ADJUSTMENTS (ines 1 through re EXPENSE: ACCOUNTS—If you had an_oxpense 7 Le or charged

Enter here and on page l,lineB . expenses to your employer, check here C).and see page 7 of Instructions,

Yr U.S, GOVERNMENT PRINTING OFFICE :1957—-O-260-001 2 . oh—10—THRSE-I


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Reference copy, JFK Collection: HSCA (RG 233)

JFE £E8S85S5INATION COLLECTION
IDEN STEEL CATION FORM

wgency: HSCA TS\ CO Wy

tecordad Numper:

Yecord Series: WNOMBERED FILES

Roency File Number: OO “ET,
jriginstor: GHyeen Reo Y, Sane .
Yrom: - R by.» Samuel........2-- eee eee eee eee R .

Dete: l-dU-7&

Docrment Type : Other Tertyal

Classification: a Cc 5 T
Restrictions: Gpen 18 1B iC 2(8) 4
Current Status: O CD x

Date of Lest Heview: / /83

Ut
o

Openiug Cr iterig:

Comments: uf Cave m ira ia ~

Box #: 102 Folder Tat ie:

NW 88326 Docid:32245535 Page 171

> =o Sree es seni is ba ERAT UME ANE wRIG, aaa A gat
7 : Reference copy, JFK Collection: HSCA (RG 233) eS

INBIVIDUAL
ae INCOME TAX
LACE PREADDRESSED LABEL HERE, If available. (Correct name and address, if necessary) Check —f<[Calendar Year

ater social security number(s) only” if incorrect or not shown on labe One: Fiscal Year Ending___1977

CEL = = — OR C TIFICATION
NAME u joint return, give first names and initials ‘al “both) LAST NAME gee PRIA Sr iaataueT ions

PRESENT HOME ADDRESS (Number and street, including apartment number, or ty Fal route)

/L2_S$@ qEr7

CITY, TOWN OR POST OFFICE, STATE AND “ZIP CODE
A .

6 Personal it tine 1 or 3 ‘checked, enter $25 t ;

If line 2, 4 or 5 checked, enter $50.
7 Dependents —
Do not list the person who qualifies you as head of household
© fam

{ ! 54) 26st en a

Total Number __ 2 x $8047 Io 80
8 Blind (see instructions) Number of blind exemptions _____— x $8 00
93 Total exemption credits (add lines $ 7 and 8) Enter here and on 1 tine 20

ae CREDITS

10 Wages, ‘salaries, “tips ‘and other employee “compensation { attach ‘pny 2 of Form(s) W.2, to face of is)
11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
12 Interest. Enter total (if over $400, complete and attach Schedule 8(540))
13° Income other than wages, dividends and interest (from line 48) ,
44 Total {add fines 10, 11, 12 and 13)
15 Adjustments to income (from line 55) .
16 Adjusted gross income (subtract line 15 from line 14)

© If you do NOT itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on tine. 19.
© If you itemize deductions OR line 16 is $15,000 or more, complete lines 17 and 18.

17 Deductions: Itemized (from line 63) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 or 5 checked)
18 Taxable income (subtract tine 17 from tine 16) Compute tax from Tax Rate Schedule—Enter tax on line 19

49 Tax from (check one) ia Tax Table ‘ax Rate Schedule CJ Income Averaging Schedule (G or Gel) .
20 Total exemption credits (from line 9, above) an . Sos .
21 Tax liability (subtract line 20 from line 19—if line 20 is greater ‘than tine 19, enter zerc) Cee ee ee ee PAP LLL De
22 Other credits (from line 68—Including Special Low Income Tax Credit) . hone
23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter zer0) Coe ee ee ee ew PAB PLT RIL.
24 Othertaxes (from line 71) 2 6 ee
25 Total tax liability (add lines 23 and 24) .
26 Total California income tax withheld (attach W-2 or W-2P to face of this return) BY 26 1
27° Renter's credit—if you lived in rented property on March 1, 1976, complete Part 1 on page 2 ce
28 1976 California estimated tax payments an 6 28
29 Excess California SDI tax withheld (see instructions) .

30 Total Credits. 2. 2 2. ee

31 If tine 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero

Mail return to: FRANCHISE TAX BOARD $$ $$$ PAY IN FULL —> =P

SACRAMENTO, CA 95867 Do not write in these spaces

32 If line 25 is smaller than line 30, enter amount OVERPAID

33 Amount of line 32 to be REFUNDED TO YOU. Allow at least six weeks.
Mail return to: FRANCHISE TAX BOARD
P.O. BOX 13-540
SACRAMENTO, CA 95813

34 Amount of line 32 to be credited on your 1977 ESTIMATED TAX . . 1. ee

if you do NOT want State income tax forms and instructions mailed to you next year, check here oO See Instructions, Page 9

<1 ATTACH COPY 2 OF FORM W-2 HERE >

TT
Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the:best of my knowledge
and belief it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

2 > SIGH ae signature . . Date > omar signat
nav a6326 Docld: 37945535 Page 1/2 r ‘sg

social security number on check or money order. ATTACH HERE >

Date


_— Te . = FRR ry q
- Reference copy, JFK Collection: #SCA (RG 233) eS ESE
Me cane eeeeteen :
an . Cnr anne = Pa ge-2-Form 540.{1976) |
PART | ~ Renter's Credit -— All questions must be answered
——_
35 Did you, on March 1, 1976, live in rented property which was your principal residence? ..... 0 Yes Ho If no, you may not claim this credit
36 Was the property you rented exempt from property tax?. w . ee ee O Yes ONo _ If yes, you may not claim this credit
37 Did you tive with any other person who claimed you as a dependent for income tax purposes?.. . . GYes OONo_ If yes, you may not claim this credit

38 Did you or your spouse claim the homeowners’ property tax exemption or receive public assistance?. O Yes O No If yes, see page 3 of instructions

PART fl — Other Income

39 Business income (or loss) (attach Schedule C(540)) 2
40 Net gain (or loss) from sale or exchange of capital assets (attach Schedule DiS40)). 1 6 es
41 Net gain (or loss) from supplementa! schedule of gains and tosses (attach Schedule D-1(540))
42 Pensions andannuities ©.) 0 a

43 Rents and royalties sche ee

. EDULE E
44 Partnerships .. 2.2... FORM (840) Jo
45 Estates andtrusts . 2...) GL Le
46 Farm income (or loss) (attach Schedule F(540)}. 0 6 6 ee

47 Miscellaneous income

(a) Fully taxable pensions and annuities (not reported on Schedule E(540))
(b) Alimony ..... a
(c) Other (state nature and source} “ _.
Enter total of lines 47(a), 47(b), and 47(c) 2 0 ee

Total (add fines 39 thru 47). Enter here and on line 13. 2 1 eee

PART Ill — Adjustments to income

49 “Sick pay,” if included in line 10 (see instructions - attach Form FTB 3805T)
50 Npoving expenses (see instructions - attach Form FTB3805U) 2 0
51 Employee business expenses (See instructions - attach Form FTB 3805N). 2 2 ee ee
52 Military exclusion (see instructions) - - - 6 6 ee
§3(a) Payments to an individual retirement arrangement (attach FTB 3805P) 2. ee ee

(b) Payments toa Keogh (H.R. 10) retirement plan. 2... ee ee

(c) Payments to a self-employed ‘Defined Benefit Plan’... 2 6 0 ee

Enter total of lines 53({a), 53(b), and 53(c) 2 2 ee a
54 Forfeited interest penalty (see instructions), ©.
55 Total adjustments (add lines 49 thru 54). Enterhere and on tine lS 2...

PART IV - Itemized Deductions

© Attach Schedule A(540) and enter sub-totals on lines 56 thru 62, below

56 Total deductible medical and dental expenses (from Schedule A(540), line 10)
57 Total taxes (from Schedule A(540), line 17). 6

58 Total interest expense (from Schedule A(540), line 20) .------ ee
59 Total contributions (from Schedule A(540), line 24) 2 2 ee
60 Total casualty loss (from Schedule A(540), line 29)... 6
61 Total miscellaneous deductions (from Schedule A(540), line 33)... 2 2 ee
62 Total child care and adoption expenses (from Schedule A(540), line 37). 2. 2. ee ee
63 Total itemized deductions (add lines 56 thru 62). Enter here and on line17 2...

PART V — Other Credits — SEE INSTRUCTIONS FOR EACH CREDIT CLAIMED BELOW

64 ‘Other State’’ net income tax credit (attach copy of other state return and Schedule $(540)). 2. 6. 6 2 ee ee ee ee @) CT rr
65 Retirement income credit (attach Schedule R(540)) 2. 2 @) 65 |
66 Special low income tax credit (see special instructions). © 0 6. @ 66 eceeedseceeee
67 Solar energy tax credit (see special instructions)... . 6... eee te ® 67
68 TOTAL (add lines 64 thru 67). Enter here and on line 22 2... ee 68

PART VI - Other Taxes

69 Tax on preference income (see instructions - attach Schedule P(540)..... ee 69
70 Tax on premature distributions from attached Form FTB 3803P ow. 70
71 Total (add lines 69 and 70) enter here and on line 24.6 6 ee 71

PART Vil - Reconciliation to Federal Return — If adjusted gross income on Federal Return is different from line 16, page 1, explain below.

NW 88326 Docid:32245535 Page 173

Reference copy, JFK Collection:

HSCA (RG 233) "he

SCHEDULE

FORM 540 |

Name as shown on Form 540

CALIFORNIA es

ITEMIZED DEDUCTIONS

Attach to Form 540

USE ONLY If YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION

Madical and dental expenses (not compensated by Insurance or otherwise) for
medicine and drugs, doctors, dentists, nurses,
hospital care, Insurance premiums for medical
care, ete.

1. One half (but not more than $150) of insurance
premiums for medical care.......................

2. Medicine and drugs...................00..00000,
3. Enter 1% of line 16, Form 540...000...0 0.0.2.0,
4, Subtract line 3 from line 2. Enter difference (if less
than zero, enter zero)......... 0. eee
5. Enter balance of insurance premiums for medical! care
not entered on line 1............0..........00 08
6. Other medical and dental expenses:
(a) Doctors, dentists, nurses, etc..................
(b) Hospitals 0602. occ ence n cues
(c) Other (itemize)__...

. Total—{Add tines 4, 5, 6a, b, and c)
8. Enter 3% of fine 16, Form 540...0........0......

9. Subtract line 8 from line 7. Enter difference (if less | |
than zero, enter zero)................00.0.00000.
144 |

10. Total—(Add lines 1 and 9. Enter here and on Form
540, line 56)...0. eee eee

Taxes
11. Auto license—Excess of registration and weight fees
(see instructions)............. 00.000 cc cece eee ee
12. Real estate. 2200s
13, State and focal gasoline...
14, General Sales.......... 0.000... cece eee
15. Personal property (Boat and Aircraft)..............
18. Other (itemize)...

17. Total tares—iAdd lines 11 thro 16. ‘Enter here and
on Form 540, line 57) ............. 0.0.0.0 eee

Interest Expense

18. Home mortgage... 02.
19, Other (itemize).............. ne en

20. Totat—(Add lines 18 and 19. Enter here and on | , Cj
Form 540, tine 58)..........0.....0.2.00002005 2 J

NW 68226 Dochd:37245535 Page 174

24. Total— (Add tines 21a thru 23.

Contributions
21(a). Cash contributions for which you have receipts,
canceled checks, etc.
(b). Other cash contributions. List donees and
AMOUMES ---------2.cseeecceceeece tee ceceanasseeneceeceenesassseenenaeansenene

22. Other than cash.—See instructions for required state-
ment

23. Carryover from 1974 & subsequent years — See
instructions

Maximum de-
duction may not exceed 20% of adjusted gross
income. Enter here and on Form 540, line 59).....

Casualty or Theft Loss(es)
NOTE: If you had more than one loss, omit tines 25
through 28—See instructions for guidance

nN

5. Loss before insurance reimbursement ,.......-+---
26. Insurance reimbursement.................00.0.000,
27. Subtract line 26 from line 25, Enter difference
(If less than zero, enter zero)... 6-2 eee eee :
28. Enter $100 or amount on line 27, whichever is
smaller.
29. Casualty 0 or theft Joss 5 (subtract | line 28 from
line 27. Enter here and on Form $40, line 60)

Miscellaneous Deductions —

30, Alimony paid to... cise cee eee e eee ence rene ee nes
31, Employment Education Expense.
32, Union dues

Other (itemize).

33. Total (Add lines 30 through 32. Enter here and
on Form 540, fine 61)

Child Care and Adoption Expense
34. Child care expenses — Attach Form 3805X..... teveees

35. Total adoption expense. ...- |

Less 3% of line 16, Form 540. -
36. Net adoption expenses — See instructions

for maximum limitations. . 6. 6. ee eee ee
37. Total child care and adoption expenses

(add liries 34 and 36, Enter here and on

Form 540, tine 62)... ........0. 04 oe


Reference copy, JFK Collection: HSCA (RG 233) “""r-ANgiFEr

. Mee i pe ;

CALIFORNIA —

DIVIDEND AND INTEREST INCOME

Attach to Form 540

‘FORM 340

lame as shown on Form 540

PART I—DIVIDEND INCOME

tine 1—Gross Dividends and Other Distributions on
tock——-lf gross dividends and other distributions (including capital
ain dividends) on stock were $400 or less, do not complete

tions), less nontaxable portion, if any, on Form 540, page 1.
Do NOT deduct the $100 federal exclusion.

“Capital gain dividends” are treated as ordinary dividends for
State income tax purposes and not as capital gains as permitted
under the federal law.

is part; but enter gross dividends (including copital gain distribu-

Gross dividends and other distributions on stock—List payers and amounts—Write (H), (W), UJ), for stock hetd by husband, wife, jointly.

Total dividends .
Nontaxable distributions .

. Taxable dividends—Subtract line 3 from line 2. Enter here and on line 11, form 540

PART II-—INTEREST INCOME

Interest on bonds, debentures, loans, notes, tax refunds and all
spes of savings accounts including banks, credit unions and postal
avings is taxable.

Interest on the following obligations is exempt from tax:

(a) Bonds and other obligations (other than tax refunds) of the
United States, the District of Columbia and territories of
the United States. (Interest on Philippine Islands obligations
issued on or after March 24, 1934 is not exempt.)

(b) Bonds (but not other obligations) of California and its polit-
ical subdivisions issued after November 4, 1902.

(c) Interest on bonds of Alaska and Hawaii issued prior to their
achieving statehood.

Note: If total taxable interest income was $400 or less, do
not complete this part; but enter the total amount of interest
received on Form 540, page 1.

Interest income—List payers and amounts. tcl cceeee ceaeeennenneeennee noon suena eesenensaeeenansuneeeeaeeeeonceesieatineescneeceneveceeieessrmeennefecescue ecsaeeeeseenefbe sconces

Se a Y PSF.

NW 88326 Docld:32245535 Page 175

more

Reference copy, JFK Collection: HSCA (RG 233) eS a oe

CALIFORNIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Propristorships)
I flo on Form 503

tach this schedulo to your income tax return, Form $40 or 540NR _— Parinorships, joint ventures, ote. must filo on Form 565
ly Ity Numbe
Name and Address of Business
e.

f
oplty PBisTRo CoFrz+ : erilae i Bi
Principat buginess activity {i.e., tetail-hardware; wholesale~tobacco; services—legal; ete). SZ#. vA
_ Indicate method of accounting: (cash, 9 fqraccrual; CU OtR OT aes eecee ences eeceenennnenne encanta nee na mo
Were Forms 591, 592, 596 and 599, tse year filed (if required)? YES (NO

Methed of inventory valuation _...... ee
Was there any substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?

CO YES (NO if.“Yes,” attach explanation.

me as shown on Form 540 or S40NR al Secur

<. 1p

Om:

1 Gross receipts, sales, or fees $........--------Less returns and allowances Gc escscnsceseecennsneenenentevenene Balance &
2 Inventory at beginning of year (if different from last year's closing inventory, attach explanation)...........

3 Purchases $...........-...—-----Less cost of items withdrawn for personal use $_........-------—- |
4 Cost of labor (do not include salary paid to yourself) / . | Sd

§ Materials and supplles........... 00.00.00 eee eee eee tn ete seers eet ens es
6 Other costs (explain.in Schedule C-2 or attach Schedule)... 0.0.0.0. 000 cee eee eens ee
7 Total of fines 2 thd 6. ..e..c oc ccc cece cece eee eet tte es ites TT
8 Inventory at end of this year... 0.0... eee eens eters ese ee eyes
9 Cost of gaods sold (subtract line B from fine 7)... 0. ees bebe bb bbb bebe eet nent b ene ee
D Gross profit (subtract line 9 from fine cca
| Other income (attach schedule)... 0.00... ccc cece eee eee erent es nese ene e ees cbc te yet teens .
2 Total income (add tines 10 and 1.2.0.2... eee ee ener eens c eee

. ‘ OTHER BUSINESS DEDUCTIONS
'3 Depreciation (explain in Schedule C-1 or attach Schedule)........

‘4 Taxes on business and business property {explain in Schedule C-2 or attach Schedule)....00... 00. eee eee [Cs
15 Rent on business property............0000 2 cece eee eee neers teens esses nese
‘6 Repairs (explain in Schedule C-2 or attach Schedule) . CSCS ( ,

i7 Salaries and wages not included on line 4 (exclude any paid to yourself)....... 2.2... 2. cee eee

WB Insurance... eee certs nese ners esses

19 Legal and professional fees......... re Soe b need bebe brett bent eter e npr rnb net e nes
30 Commissions ... 00.0... 2.0000 e eect eres nets ee eee icc ee |
14 Amortization (attach statement)... 00.00.0060. 0 0c eet n nes |
72 Retirement plans, etc. (other than your share, see instructions). eee | SY
°3 Interest on business indebtedness..........-...----00 02ers Mc e ete nee e teen tees TCS

"34 Bad debts arising from sales or services (Not applicable if reporting on cad, baris) ccc vtec eteveteneeee | —sSY
ae ;

28 Depletion (attach schedule).......... 0.60020. e ieee ee reenter Tennessee

96 Other business expenses (explain in Schedule C-2 or attach Schedule).................05-02 20 eee e renee [C—SY e
“7 Total of fines 13 thy 26.0200... eee net re shaming

28 Net profit (or loss) (subtract line 27 from fine 12), Enter here and on Page 2, Form 540 or S40NR....... oe. ae ee | bce cee ed | Sc“

Cost or Depreciation Method of Life or Depreciation
. allowed (or allowable) computing prec
other basis in prior years depreciation Rate for this year

Group and guideline class Date

bg or description of property Acquired

—=so

eee [

BBs a RO (OO

ase C—O ee
& [Oo

[eee __

7 a

aS -

Ssk a a DO

gee [oO

Ses a NL GS .
as RC CO

- te ‘ . 2 aT “eae
Reference copy, JFK Collection: HSCA (RG 233)

GALIFORWIL = = pa

ie sd CAPITAL GAINS AND LOSSES

Attach to Form 540 or 540NR

Use this schedule to report gains and losses on stocks, bonds and similar investments,
and gains (but not losses) on personal assets such as a home or jewelry.

Name as shown on Form 540 or 540NR

yas
PART l—Assets Held Ona Year or Less
@. Cost or other basis as
adjusted, cost of subte.
a. Kind of property and description b. Date acquired c. Date sold d. Gross sales quent improvements (if f. Galn or loss
(Example, 100 shares of ‘‘Z'' Co.) (mo,, day, yr.) (mo., day, yr.) price not purthesed, attach Cd. fesse.)

explanation) and ex
pense of sale

2. Enter gain ‘(or loss), if applicable, from line 17, Schedule D-1 (540) (attach copy) .
3. Enter your share of net gain or loss from partnerships. and fiduciaries .
4. Net gain or loss, combine lines 1, 2 and 3

PART il—Assets Held More Than One Year But Not More Than Five Years

6. Enter gain (or loss), if applicable, from line 19, Schedule D-1 (540) (attach copy) .
7. Enter your share of net gain or loss from partnerships and fiduciaries . .
8. Net gain or loss, combine lines 5, 6 and 7 (If gain, see 540 instructions, line 24a (Preference Income))

10. Enter gain (or loss), if applicable, from line 21, Schedule D-1 (540) (attach copy). 2... ww en .
11. Enter your share of net gain or loss from partnerships and fiduciaries . See eee
12. Net gain or loss, combine lines 9, 10 and 11 (If gain, see 540 instructions, line 24a (Preference Income))

PART iV—Summary of Capital Gains and Losses

13. Enter amount from line 4 .
14, Enter 65% of the amount on line 8 . .
15. Enter 50% of the amount on line 12...
16. Enter unused capital loss carryover from preceding taxable vey 45, , computation
17. Combine the amounts shown on lines 13, 14, 15 and 16
18. If line 17 shows a gain, enter here and on page 2, Part il of Form 540. or ‘540NR .
19. If line, 17 shows a loss, enter here and on page 2, Part Il of Form 540 or S40NR the smallest of:

(a) amount on lines 17;

{b) the taxable income-for the toxable year (computed without regard to gains or losses from sale or exchange

of capital assets; or

(c) $1,000 ($500 in the case of a husband or wife filing a separate return)

NW 88326 Docid:32245535 Page

5

RESIDENT

Reference copy, JFK Collection: HSCA (RG 233)

TAXABLE YEAR

INDIVIDUAL
CALIFORNIA.
INCOME TAX

PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary)

Enter social security number(s) only if incorrect or not shown on labet.

NAME Jif joint return, give first 2; initials of both)
AMMUEL LP 3

Check Soetalendar Year
One: {7} Fiscal Year Ending

; " FOR FEDERAL PRIVACY ACT NOTIFI-
LAST NAME CATION SEE PAGE 2 OF INSTRUCTIONS

1976

: at.
Spouse's Social
Qo: -

~

OCCU.

Yours
PATION

Spouse's

an 6,
FILING STATUS—Check
1 & Single
2K Married filing joint return (even if only one had income)

If line 1 or 3 checked, enter $25
6 Personal If line 2, 4 or 5 checked, enter $50). 2 2. |. Le

7 Dependents — Do not list yourself, your spouse or the person who qualifies you
as head of household. Enter name and retationship.

3 (1 Separate return of martied person—Enter spouse's
social security number and full name here

ELISA
THOMAS

8 Blind (refer to instructions) Number of blind exemplions B® a X $8
3 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20

4 () Head of Household Enter name of qualifying
individual ce ee eee

CO Widow(er) with dependent child (Year spouse died 197___)

wo

{ Attach copy 2 of Formis} W-2 to face of this ?
} return. If unavailable, see mstructions, Page 6 4

10 Wages, salaries, tips and other employee compensation
11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
12 Interest. Enter total (if over $400, complete and attach Schedule B(540) )

13 Income other than wages, dividends and interest (from line 48)

14 Total (add fines 10, 11, 12 and 13)

15 Adjustments to income (from tine 55) . .

16 Adjusted gross income (subtract line 15 from line 14)

© If line 1 or 3 is checked and line 16 is $4,000 or less, enter zero tax on line 23. Bo not complete
© If ling 2, 4, of 5 is checked and line 16 is $8,000 of less, enter zero tax on line 23. 7 lines 17 thru 22

© If you do NOT itemize deductions AND line 16 is under $15,000, find tax in Tax Table and enter on tine 19.
© If you itemize deductions OR tine 16 is $15,000 or more, complete lines 17 and 18.

17 Deductions: Itemized (frum me 62) OR STANDARD ($1,000 if line 1 or 3 checked—$2,000 if line 2, 4 ot 5 checked)
18 Taxable income (subtract tine 17 trom Jine 16) Compute tax fyem Tax Rate Schedule—Enter tax on tine 19

“4 ATTACH COPY 2 OF FORM W-2 HERE »

19 Tax from (check one) Tax Table Tax Rate Schedttegy Income Averaging Schedule (G or G-1) O
20 Total exemption credits (from fine 9, above) 7

21 Tax liability (subtract tine 20 from line 19—if line 20 is greater than line 19, enter zero)

22° Other credits (from line 65) i ,
23° “Net tax liability (subtract line 22 from line 2!—-if line 2? is greater than tine 21, enter zero)
24 Tax on preference income (see instructions—attach Schedule P(540) )

25 Total tax liability (add lines 23 and 24) So

26 Total California income tax withheld (attach W-2 or W-2P to face of this return) 2
27° Renter's credit—if you lived in rented property on March 1, 1975, complete Part 1 on page 2 . .&&

28 1975 California estimated tax payments . . 2. | . a |
29 Excess California SDi tax withheld {attach Form DE 1964 to face of this return) , « ee
# 30 Total prepayment credits (add tines 26 thru 29) So, mm | 30 —O
= 31° If line 25 is farger than tine 30, enter BALANCE DUE. ff it is equal to line 30, enter zero. .
oe Pay in full and mail with return to: FRANCHISE TAX BOARD PAY IN FULL ——> & =) —
a
- SACRAMENTO, CA 95867 Do not write in these spaces
=) 32 If fine 25 is smaller than line 30, enter amount OVERPAID ne oy)
z 33 Amount of fine 32 to be REFUNDED TO YOU. Allow at least six weeks.
S Mail return to: FRANCHISE TAX BOARD a 33 E
: P.O. BOX 13-540 M
& SACRAMENTO, CA 95813 A
Ee
=< 34 Amount af line 32 to be ctedited on your 1976 ESTIMATED TAX. 7 Es &——— ESTIMATED TAX| R

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief it is true, correct and complete. If prepared by a person other than taxpayer, his declaration is based on alf informotion of which he has any knowled3e.

SIGN >i signature Date | >

rite social security number on check or money order. ATTACH HERE >

Preparer’s signature (other than taxpayer) ee ne og Date

=
NW salad! FRE Paasche -PageaTae i ate

Reference copy,

JFK Collection: HSCA (RG 233)

SCHEDULE

FORM 540

Name as shownon Form 540 _
A EL LL!

If your adjusted gross Income is $8,000 or less and your fillng status is “Married, Filing Jointly, " “4 40 of Household,” or “Widowler) With Dependent child, ‘
do not itemize, enter zero on Form 540, line 23, and check the tax

or $4,000 or tess and your fillng status Is “Single,”
table box.

r “Married, Filing Separately,”

CALIFORNIA

ITEMIZED DEDUCTIONS

Attach to Form $40

A

USE ONLY (F YOU DO NOT USE THE TAX TABLE OR TAKE THE STANDARD DEDUCTION

Medical and dental expensas (not compensated by insurance or otherwise) for
medicine and drugs, doctors, dentists, nurses,
hospital care, insurance premiums for medical
care, ete.

1. One half (but not more than
premiums for medical care

2. Medicine and drugs
3. Enter 1% of line 16, Form 540

4. Subtract line 3 from line 2. Enter difference (if less
than zero, enter zero)

$150) of insurance

5. Enter balance of insurance premiums for medical cate
not entered on line I

6. Other medical and dental expenses:
(a) Doctors, dentists, nurses, etc.
(b) Hospitals 00000200020 Joe.
(c) Other (itemize)...

7. Total—(Add tines 4, 5, 6a, b, and c)...... 00...

8. Enter 3% of line 16, Form 540.......... 20.0...

§. Subtract line 8 from line 7. Enter difference (if less
than zero, enter zero).

. Total—tAdd lines 1 and 9. Enter here and, on Form
540, line 56)...

Child Adoption Expense
11. Total expenses paid or incurred—Attach itemized list
12, Enter 3% of line 16, Form 540..................
13. Subtract line 12 from line 11—See instructions for

maximum limitations. (Enter here and on Form 540,
fine SI). ene ee

Taxes

14. Real estate... 66.2 .
18. State and focal gasoline... 0202... eee
16. General Sales.......0.00.000.00 cece cece ee

17.

Auto license—Excess of registration and weight fees
(see instructions)... ......0....... 0.0 c eee eee

Personal property (Boat and Aircraff)..............
Other (itemize). esc eeeeeeeeceeeeeeceeceseeecetcceee ot

18.
19.

2

interest Expense

21.
22.

23. Total—(Add Isnes 2! and 22. Enter here and on

Contributions —
24,

25.

26.

~

. Carryover

28.

Miscellaneous Deductions

Casualty or Theft Loss(es)—See instructions
NOTE:
through 33 and follow instructions for guidance.

29.
30.

31.

32.
33.
34.
35.
36.
37.
38.

38.

Home mortgage
Other (itemize).

Form 540, line 59)

Cash contributions for which you have receipts,
canceled checks, etc.
Other cash contributions.

List donees and amounts

Other than cash.—See instructions for required state-
ment . . Ce ett eee
from 1974—See instructions..........
Total—tAdd lines 24, 25, 26, and 27. Maximum de-
duction may not exceed 20% of adjusted gross
income. Enter here and on Form 540, line 60)

If you had more than one loss, omit lines 29

Loss before insurance reimbursement
Insurance reimbursement

Subtract line 30 from line 29. Enter difference (if line
30 is greater than line 29, enter zeio)............
Enter $100 or amount on line 31, whichever is smaller
Casualty or theft loss (line 31 Jess fine 32)........
Alimony paid... eee
Child care—See instructions
Union dues. eee eee
Employment educatlon expense—See instructions...
Other—titemize)

Total—Add lines 33, 34, 35, 36, 37, and 38.
here and on Form 540, line 61)

(Enter


Reference copy, JFK Collection: HSCA (RG 233)

“Fr

GALIFORWIA ae

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprieterships)

Partnorships, joint vontures, otc., must Alo oa Form 365

yen, Form 540 or SG4ONR

C. Principal business activity (i.e, retailhardware; wholesale~tobacco; services—legal; etc.)
D. Indicate method of accounting:  ( cash; acer CO other,
E. Were Forms 591, 592, 596 and 599, for the cig filed (if required)? Lies O NO
F. Method of Inventory valuation Bm. te nec cccce eceneeeeceeeeesneteceneeenensaneees cscs sveeeeeceeseecseeceeneenpisteciesssesceneenesersss nesesonesueneeteceessserssosseanersersereceansaesucaes weeeeeneescs
Was there any substantial change in ‘the manner of determining quantities, costs, or valuations between the opening and closing inventories?
O YES (NO If “Yes,” attach explanation.

1 Gross recelpts, sales, or fees $0. .0.............Less returns and allowances $202
2 Inventory at beginning of year (if diferent from last year's closing inventory, attach explanation)...........
3 Purchases $. |. Less cost of items withdrawn for personal use $ ..
4 Cost of labor (do not include salary paid to yourself)
5 Materials and supplies................. Se eee bebe
6 Other costs (explain in Schedule C-2. or attach Schedule). Se ee be beet ee be vee tees
7. Total of tines 2 thu 6............... ee ee been e beer eee nee
8 inventory at end of this year... Cee be beeen eee
9 Cost of goods sold (subtract line 8 from line n rn cose ee
10 Gross profit (subtract line 9 from line 1)
11 Other income (attach schedule)...... . . Lo Cee _ . Se cee
12 Total Income (add lines 10 and 11).. vee . . ee beet nett bee beeen eee
OTHER BUSINESS DEDUCTIONS
13 Depreciation (explain in Schedule C-1 or attach Schedule) .
14 Taxes on business and business property (explain in Schedule C-2 or attach Schedule). Lo. rn
15 Rent on business property .
16 Repairs (explain in Schedule C-2 or attach Schedule)
17 Salaries and wages not included on tine 4 (exclude any paid to yourself)
18 Insurance eee ee
19 Legal and professional fees, 0 8 .
20 Commissions .. Looe ee eee
21 Amortization (attach statement). rn re Snes
22 Retirement plans, etc. (other than your share, see ‘instructions)
23 Interest on business indebtedness... 0.202. cence eee
24 Bad debts arising from sales or services (Not applicable if reporting on cash basis).... © | 200...
25 Depletion (attach schedule). . ene bern e evens
26 Other business expenses fexplain in Schedule C2 or attach Schedule). . bbe beens
27 ~~ ‘Total of UInes 13 thru 26. a ar

Depreciation Method of

: Group and guideline class Date Cost or ‘ Depreciation
a Pr : . allowed (or allowable) computing :
wes or description of property Acquired other basis in prior years depreciation for this year
o.2 ef
Ss
oC
es
253
3aE
oa
x]
Sis EXPLANATION
£& ;
so
oo &
BEs
Be"
352
go


Reference copy, JFK Collection: HSCA (RG 233)

CALIFORNIA

CAPITAL GAINS AND LOSSES

Attach to Farm 540 or S40NR

TAXABLE

SCHEDULE |

FORM 540

Use this schedule to report gains and losses on stocks, bonds and similar investments,
and gains (but not losses) on personal assets such as a home or jewelry.

Name as showin on Form 540 or 540NR// 4 , ~SoelT Be
AMUAEL | i iY (erie:

i es ae f\ A Pe ne aan, cel

PART !—Assets Held One Year or Less

: @. Cost or other basis as
adjusted, cost of subse-
a. Kind of property and description b. Date acquired t. Date sold . Gross sales quent improvements (If ft. Gain or loss

(Example, 100 shares of ‘‘Z" Co.) {mo., day, yr.) (mo.. day, yr.) orice fot purchased, attach (d. fesse.)
explanation) and = ex-
pense of sale

—oltald Loss. cn ee ED oc ccccssessnefesssessesesnttnesiseeenfecseeesesesennsstaeeei
a core (v0, 3 6 0 “ye : worsens eenenneens nena eee
USED [2724 JOR/D- |

> tne gain (or loss), if applicable, from line 18, Schedule D-1 (540) (attach copy) .
3. Enter your share of net gain or loss from partnerships and fiduciaries .
4, Net gain or loss, combine lines 1, 2 and 3

_ PART ll—-Assots Held More Than One Year But Not More Than Five Years

6. Enter gain (or loss), ‘if applicable, from line 20, Schedule D- 1 (540) (attach copy) .
7. Enter your share of net gain or loss from partnerships and fiduciaries .
8. Net gain or loss, combine lines 5, 6 and 7

PART IIl—Assets Held More Than Five Years

10. Enter gain (or ‘loss), if applicable, from line 22, Schedule D-1 (540) (attach copy) .
11. Enter your share of net gain or loss from partnerships and fiduciaries .
12. Net gain or loss, combine lines 9, 10 and 11

PART iV—Summary of Capital Gains and Losses

13. Enter amount from line 4
14. Enter 65% of the amount on line 8
15. Enter 50% of the amount on line 12.
16. Enter unused capital loss carryover from preceding taxable years (attach compotion
17, Combine the amounts shown on lines 13, 14, 15 and 16
18. If line 17 shows a gain, enter here and on page 2, Part Il of Form 540. or ‘540NR
19. If line 17 shows a loss, enter here and on page 2, Part Il of Form 540 or 540NR the smallest of:
(a) amount on lines 17;
(b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
of capital assets; or

NW B8326 SON: 3I99455¢5+Page 484 hoshand ac wife fillan ao cannarnte return)

Reference copy,

BSCA (RG 233)

JFK Collection:

FORM 540

Name as Showa on Tax Return
Sammut. £
a aa

PART |

CALIFORNIA

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES

(Sales or Exchanges Including Involuntary Conversions)
(Attach to Form 540, S40NR, 541 or 565)

Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220

Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.

Date acquired
(mo., day, yr.)

1. meas of Sections 18211, 18212-18, 18219, one 18220 property. _

VU OP LEY. Bit CoFFEEe

Correlate lines 1(A) through 1(D) with these columns oe ad

Gross sales price Loe
. Cost or other basis and expense of sale
Depreciation allowed (or allowable)
Adjusted basis, line 3 fess line 4
. Total gain, subtract line 5 from line 2
if Section 18211 property:

N[oa a awn

(a) Depreciation allowed (or allowable) after applicable date.

(See Instruction D-3) .
(b) Line 6 or line 7(a), whichever is smaller
8. if Section 18212-18 property:
(a) Enter additional depreciation after 12-31-63 and before
1-1-7] ,
(b) Enter additional depreciation after 12. 31 70
(c) Enter line 6 or line 8(b), whichever is smaller .
(d) Line 8(c) times applicable percentage (Instruction D- 4).
(e) Enter excess, if any, of line 6 over line 8(b)
(f) Enter line 8(a) or line 8(e), whichever is smaller .
(g) Line 8(f) times applicable percentage (Instruction D-4)
(h) Add line 8(d) and fine 8(g) . . oo.
9. If Section 18220 property:
(a) If farm land, enter soil and water conservation expenses
for current year and four preceding years

(b) If farm property, other than land, subtract line 7(b) from

line 6; OR, if farm land, enter line 6 or line 9(a), which-
ever is smaller (see Instruction D-5)
(c) Excess deductions account (see Instruction D-5)
(d) Enter line 9(b) or line 9{c), whichever is smaller .
10. tf Section 18219 property:
(a) Soil and water conservation expenses made after 12-31-69
(b) Enter amount from line 9(d), if any; otherwise, enter a zero
(c) Enter excess, if any, of line 10(a) over 10(b)
(d) Line 10(c) times applicable percentage (Instruction D-5)
(e) Line 6 less line 10(b)
(f) Enter smaller of line 10(d) or line 10(e)
SUMMARY OF PART I
11. Enter amounts from line 6... . .
12. Enter amounts from lines 7(b), B(h), 9(d) ‘and 106) toe
13. Subtract line 12 from line 11, enter here and in appropriate
Section in Part Il (see Instruction D-2)

14. Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part Ill

NW°88320-Docldt32245935 Page 182

(Complete Property Columns (A) through (D) up to Line 10(f) before going to Line 11)

Date sold
(mo., day, yr.)

Property
(B)

Property
(A)

Property
(Dd)

Property
(C)

| LPP.


Reference copy, JFK Collection: HSCA (RG 233)

Lf. “CALENDAR YEAR 19 AS
“ADDRESS

MEDICAL Pstare  [ Feoenat (CONTRIBUTIONS FEDERAL
a

2 MEDICINE/DRUGS _
3 LESS 1% A.GA. (Line 18 - 1040)
4NET MED/DRUGS
5H &AINS. (4 + EXCESS)
6a DR.

DR.

oR.

ae |

”

OR. \ ;
oR. ;

—

sURHREEEEE
SHI:

6b HOSPITAL _
PROSTHETIC APPLIANCES
HEARING AIO

CASUALTY OR THEFT (LOSS(ES)
25 LOSS BEFORE ADJUSTMENT
26 INSURANCE REIMBURSEMENT

_Ge AMBULANCE
LABORATORIES 26 ($100 LIMITATION PER.CAS.)
TRAVEL FOR MED. i tf 29 ror. CaS OR THEFT LOSS

a MISCELLANEOUS DEDUCTIONS

30 ALIMONY

31 UNION /PRUF SIONAL DUES
TE.2-7F | [32 cuiro a ver. cane (Form 2441)
33 INCOME TAX PREPARATION
UNIFORMS/PROTEC, CLOTHING
SMALL TOOLS AND SUPPLIES
LAUNDRY AND CLEANING
AUTO USE/UAMAGE

INV EST. COUNSE L & PUBS. (Sched
EMPLOYMENT AGENCY FEES
SAFE DEPOSIT BOX
TEL. REQ. IN BUSINESS
POLITICAL CONTHIBU TIONS

___MEDICARE INS.
GLASSES _
TMEDICAL EXPENSES
LESS REIMBURSED BY INS.
8 LESS 3% ADJ. GROSS INC.
9 a
1+:% (TO $150) OF H & A INS. _
10 roTAL MEDICAL DED.
TAXES
TISTATE & LOCAL INCOME
TZREALESTATE
12 STATE & LOCAI. GASOLINE
14 GENERAL SALES TAX
15a PERSONAL PROPERTY ;
15b PERSONAL PROPERTY AUTO
16 saLES TAX AUTO

34 rorAL MISC. DED.

SUMMARY OF ITEMIZED DED. STATE FEDERAL

TOF Gr DUCTIALE MEDICAL & DENTAL
EPPENSES TE ROM LINE 10)

36 TOTAL TAXES (From LINE 17)

37 TOTAL INTEREST (Line 20) -——|—|

17 TOTAL TAXES ___ bl [%
INTEREST (TO WHOM PAID)
18 MORTGAGE

38 TOTAL CONTR. (Line 24)

39 CAS. & THEFT LOSS(ES) (Line29)

40 TOTAL MISCELLANEOUS
OEDUC TIONS (FROM LINE 34)

Ay Porat TTEMIZ ED DEDUCTIONS
ENTER ON FORM 1040 LINE 45

REMARKS

2OTOTALINTEREST ss LOE

0 bd . Ferny Vibe SCHEDULE

NW 88326 Docld:32245535 Page 183 -

Reference copy, JFK Collection: BSCA (RG 233)

NAME

ADDRESS FISCAL YEAR ENDING

19

SCHEDULE OF PROFIT ( OR LOSS y FROM BUSINESS OR PROFESSION

PRINCTR4SL BUSINESS ACTIVITY
BUSINESS NAME EMPLOYERS NO.

nna e ee

BUSINESS ADDRESS

I

TOTAL RECEIPTS
paneer
INVENTORY AT BEGINNING OF YEAR

MERCHANDISE PURCHASED

i
TOTAL

LESS INVENTORY AT END OF YEAR

a

GROSS PROFIT

AGWFATISING

ager SP TRUCK EXPENSE

fan. ne ais

c OMM TE ss TONS

ObR LIVER

DErPLEIATION ( SUMPDULR BLLUe

SUES AND SURSCRIPTIONS

nanan

ENTERTAINMENT AND PROMO T? ONAL

INSURANCE

INTEREST

PANE EOR ANU “AUL Ihe

any ft ZPUNSE

OPP ECE SUPPLIES

RENT

REPAIRS AND MAINTONANCE

SALARIES AND WAGES

SUPPLIES

TAXES AND LICENSES

TAYES PAYROLL

TELEPHONE AND UTILITIES

~Boialt es as TRB zB re) R

NET PROFIT eR {Loss } FEDERAL RETURN ‘
NED PROFIT OF (L055 ) STATE RETURN « SFE DEPREC. SCHEQULE FOR DIFF. Ariz wT Tt |
SCHEDULE OF DEPRECIATION

DATE YEARS | COST OR PRIOR [DEPRECIATION
KIND AND L LOCATION | QF PROPERTY | acguiReo . | OR % | OTHER BASIS DEPREC.

PROFESSIONAL STATIONERS INC FORM 1OAA
LOS ANGELES, CALIF.

NW 88326 Docld:32745535 Page 184

SCHEDULE

Reference copy, JFK Collection: HSCA (RG 233)

al route)

Ge Rept eed cae 1 Bbatastinet a lead gaa w) UNE yE
Lee ee ee }
FL 3
RESIDENT INDIVIDUAL ie
CALIFORNIA |
INCOME TAX |

PLACE PREADDRESSED LABEL HERE, if available. (Correct name and address, if necessary) For calendar year or
Enter social security fumber(s) only if incorrect or not shown on label. : Taxable year ending 4 197 |
NAME (ip jpint return, a and initials of both) F Ce Your Social Security Number
[

occy
PATION

| Yours

Spouse’

FILING STATUS—Check Only One:
1 © Single
2 Married filing joint return (even if only one had income)

EXEMPTION CREOITS If line 1 or 3 checked, enter $25
6 Personal If line 2, 4 or 5 checked, enter $50

7 Dependents — Do not list yourself, your spouse or the person whu qualifies you
as head of household. Enter name and relationship.

4 (J Head of Household—Enter name of qualifying Total Number & __ a x $8
individual, - -}8 Blind (refer to instructions) Number of blind exemptions » __.

5 0) Widowler) with dependent child crear spouse died » 197_)] 9 Total exemption credits (add lines 6, 7 and 8) Enter here and on line 20

3°C Separate return of married person—Enter spouse's
social security number and full name here

10 Wages, salaries, tips and other employee compensation | At!2ch copy 2 of Boras) TW-2 ta face of this |

) return. tf unavailable, attach explanation.

11 Dividends—before federal exclusion. Enter total (if over $400, complete and attach Schedule B(540))
12 Interest. Enter total (if over $400, complete and attach Schedule B(540))

13 Income other than wages, dividends and interest (from tine 48)

14 Total (add lines 10, 11, 12 and 13)

15 Adjustments to income (from line 54)

16 Adjusted gross income (subtract line 15 from tine 14)

+ If you do NOT itemize deductions AND line 16 is under $10,000, find tax in Tax Table and enter on line 19.

* If you itemize deductions OR line 16 is $10,000 or more, complete lines 17 and 18.

17 Deductions: itemized (from line 61) OR Standard ($1,000 if line 1 or 3 checked—$2,000 if fine 2, 4 or 5 checked)
18 Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on fine 19

eee ee A eRe

19 Tax from (check one) Tax Table (7) Tax Rate Schedule y Income Averaging Schedule (G o G-1) 0
20 Total exemption credits (from line 9, above)

21) Tax Hability (subtract line 20 from tine 19—if line 20 is greater than line 19, ‘enter reo)

22> Other credits (from line 65—Includes special low income tax credit) .

23 Net tax liability (subtract line 22 from line 21—if line 22 is greater than line 21, enter + 2er0)
24 Tax on preference income (see instructions—attach Schedule P(540))

<4 ATTACH COPY 2 OF FORM W-2 HERE »

genet

A 25 Total tax liability (add fines 23 and 24)
=
= 26 Total California income tax withheld (attach Form(s) W-2 or W-2P to face of this return) :
© 27 Renter's credit—it you lived in rented property on March 1, 1974, complete Part 1 on page 2 . i
E 28 1974 Catlfornia estimated tax payments f
'g 29 Excess California SDI tax withheld (attach Form DE 1964 t to face of this ‘return, _. . Be
E 30 Teta prepayment credits (add lines 26 thru 29)... | 2 2 ee
= s :
2 = 31 If tine 25 is larger than line 30, enter BALANCE DUE. If it is equal to line 30, enter zero. —_ ‘
4 E Pay in full and mail with retura to: FRANCHISE TAX BOARD PAY IN FULL —>
a 5 SACRAMENTO, CA 95867 Do not write in these spaces °
w & 32 If line 25.is smaller than line 30, enter amount OVERPAID z
Qa = i
Zc Mail return to: FRANCHISE TAX BOARD :
=o P.0. BOX 13-540 : . .
= Ss. : SACRAMENTO, CA 95813 M ‘i
3 E 33° Amount of line 32 to be REFUNDED..(Allow at least six weeks) -——— REFUND TO YOU —» 33 ["
E £ 34 Amount of line 32 to be credited on your 1975 ESTIMATED TAX . . . | 34 A .
4 7
2 Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and stotements, and to the ‘best of my knowledge and E
&. boliof it is true, correct ond complete. If preparod by a person othor than taxpayer, his doclaration is based on all information of which he has any knowledge. i
3 Ff
a
2 SIGN > vou signature Dats B seat rate oe than taxpayer) f
x 717 VANOWEN STREE i
NW ae HERE Praozaass05-Page 105 return Date Address (and Zip code) 0 ey an srne,


Reference copy, JFK Collection: HSCA (RG 233) tganeg-.

CALIFORNIA

ITEMIZED DEDUCTIONS

Attach to Form 540

TAXABLE

Use only ‘it you do not use the Tax Table or take the standard deduction.

Medical and dental expenses (not compensated by insurance or otherwise) for interest Expense
— medicine and drugs, doctors, dentists, nurses, hospi- ,
tal care, insurance premiums for medical care, etc. 22. Home mortgage .

. 23. Installment purchases

1. One half (but not more than $150) of insurance 24. Other (itemize)

premiums for medical care
2. Medicine and drugs 2 2 2... ee ee ee Pepe. ecceneeesey veaveneviees teveaecees cis toute cer ce cesnumtcts feneeens  )ocaeeaceeeeereecbeeseees

3. Enter 1 1 of adjusted Bross income shown on Form

4. Subtract line 3 from tine 2. Enter difference (if line
3 is greater than fine 2, enter zero)

5. Enter. balance of insurance premiums for medical
care not entered on line 1 .

6. Other medical and dental expenses:
(a) Doctors, dentists, nurses, etc.
(b} Hospitals .

(c) Other (itemize) .

25. Total tAdd lines 22, 23 ‘and 24, Enter here an
on Form 540, page 2, line 58)... . YG

Contributions oo

26. Cash contributions for which you have receipts, ¢ can-
celed checks, etc.

27. Other cash contributions. List donees and amounts

7. TotaltAdd tines. 4, 5, ‘6a, i" and 0) rs rs i
8. Enter 3% of adjusted _Bross income shown on
Form 540... Loe

28. Other than “cash. — See instructions . for “ewuted

9. Subtract fine 8 from line 7. Enter difference (if statement

line 8 is greater than line 7, enter zero)

uo 29. Total—{Add tines 26, 27 and 4 Maximum deduction Ay
10. Total—iAdd lines 1 and 9. Enter here and on . "may not exceed 20% of adjusted gross income.
Form 540, page 2, tine 55). > L3S¢ Enter here and on Form 540, page 2, tine 59) . > ]

Child Adoption Expense ; Miscellaneous Deductions
Casualty or Theft Loss(es}—See Instructions
1. Has expenses paid or ncurred—Attach itemized NOTE: If you had more than one loss, omit lines 30
. . ne ree res through 34 and follow instructions for guidance.

12. Enter 3% of adjusted gross income shown on Form 30. Loss before insurance reimbursement . . . . .
SQ 31. Insurance reimbursement . . . .

13. Subtract. line 12 from line 11—See instructions 32. Subtract line 31 from tine 30. Enter ditterence tit
for maximum timitations. (Enter here and on Form ine 31 is greater than tine 30, enter zero) . ©.
540, page 2, line 56) rd 38. Enter $100 or amount on line 32, whichever is

smaller

34. Casualty or theft loss ine 32 less line 331

35. Alimony pald

36. Child care—See instructions

37. Union dues

38. Employment education expense—See instructions
39. Other—See instructions (itemize) .

Taxes

14. Real estate

15. State and local gasoline
18. General sales

17. Auto license-——Excess of registration a and weight fe fees
(see instructions) . :

18. Personal property .

19. State disability insurance (SDl)—Employer Private
disability plans do not qualify . .

20. Other 2... 2 lo ae
21. Total taxes—{Add lines 14 through 20. Enter here 0 40. Total—Add lines 34, 35, 36, 37, 38 and 39. (Enter
and on Form 540, page 2, line 57) . : Y here and on Form 540, page 2, ‘ine 60).

NVW88276, Docid:32245535 Page 186

K pireres YY

aT)

[otro eee

SO ee eg Co TT oR NR ED RE REO EL

Yee, 2 renee nae

cetiee cee +

co

wR ee - : 7 “. Reference copy, JFK Collection: HSCA (RG 233)

) CALIFORIIA

PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Solo Propriatorships)

SCHEDULE

FORM 3540

Attach this schedule to your income tax return, Farm 540 or S40NR —_—_— Pertnorships, joint vonturas, otc., must file on Form 565

Name as shown on Form 540

ee, DOCial Security Number

A. Principal business activity te R " Cc eo ceed product... LOA CC “than.

(See Instructions for “Item A.” (For Wa retail—-herdwores. ree ONE pprobenses 1 elcar loess monvfocturing—furniture; etc.)

B. Busine: me.. Woo PLE ral loyer identification nymb E52 ASE. Fé...
D. Business address (OLS 5 PisTR RA CyPreet. y CA wo “CANS "9 93/76

E. Indicate method of accounting: (_} cash; WW accrual; Oj 2 - ceeeeeteeeeteeeeee
F. Were Forms 591, 592, 596 and 599, are calendar year filed (if required)? “¥ Yes” D ‘No.
G. Method of inventory valuation > “ST

Was there any substantial change in the manner of determining quantities, costs, or + valuations between the c opening 3 and closing Inventories?

O) Yes NO. _ If “Yes,” attach explanation.
IMPORTANT—A!l applicable lines and schedulos must be Allod in.

" 1 Gross receipts or sales $s Less returns and allowances $_......______... Balance ee oo.
S| 2 Less: Cast of goods sold (Schedule C-1, line 29) and/or operations (attach schedule). 2 2. 1 2.
Q| 3 Gross profit... | Se ee a.
Z| 4 Other income (attach schedule) Ck ke
5 TOTAL income (add lines 3. and 4) . 2. 1. wee ee | SY
6 Depreciation (explain in Schedule C-3) . . . . a ces ie
7 Taxes on business and business property (explain in "Schedule (> ) re Se
8B Rent on business property 2. 6. ee ac tecencescectecedeeeees
9 Repairs (explain in Schedule C-2) 2 6 1 fcc eceneceecnereefeceeee
10 Salaries and wages not included on line 24, Schedule C- 7 (exclude a any ‘paid t to yourself) . -
1} Insurance. a Ser es Deenene
12 Legal and professional fees . oe seeeeeeceeseeceneecueeeeedecee eee
13 Commissions . on nee
14 Amortization (attach statement) wee re ne ieee
{TS (a) Pension and profit-sharing plans (see Instructions for line 15(a)) wee ee ee kk _
3 (b) Employee benefit programs (see Instructions for line 15(b)) 2-6 hee ceannnsecbeseeee
5 16 Interest on business indebtedness . ree Pree
3/17 Bad debts arising from sales or services 2 | i eeettteee cee eteetece bce
@/18 Depletion . . . rs [eee Meee
9159 Other business expenses o (pects
(a)...
(b)... esseeeeeccceene
(c)...
(d)..
(e)...

(h). Total other business expenses (add lines 19(a) through 19(g)) . See ee ew ge
20 Total deductions (add lines 6 through 19). 2 1. we ee ee CR

21 Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR ©

SCHEDULE C-1. COST OF GOODS SOLD (See Schedule C Instructions for fine 2)

22 Inventory at beginning of year (if different from last year’s closing inventory, attach explanation)
23 Purchases $0... ... Less cost of items withdrawn for personal use $....................... Balance >
24 Cost.of labor (do not include salary paid to yourself) 2. 2... ;
. 25 Materials and supplies 2 6 2 6 6 we ee

26 Other costs (attach schedule) 2 2 5. 1 we ee tt ee te .
27 Total of lines 22 through 26 2 6 1 ac acennneneeecfeceeeee
28 Less: Inventory at end of year. . 6. Ce ke ee ek
29 Cost of goods sold. Enter here and on line 2, ‘above

Nw-88226 Docld:32245535 Page 187

Naam 9 mor rere ne

en RE Sop) San ee

TE Me ener gee cnrecegny eget nitnae

ELA RRR ee one me RTT Ie re OE Ree eee

Reference copy, JFK / Collection: HSCA (RG 233) ""~

SCHEDULE

%
.
i
i
1
t
{
1
\
if
FT sao? agen n «

CAPITAL GAINS AND LOSSES

Attach to Form 540 or S40NR

Use this schedule to report gains and losses on stocks, bonds ond similar investments,
and gains (but not losses) on personal assets such as a home or jewelry.

Name ag shown on Form 5 ONR /)
a wer Pi tert U_-

PART I-——Assets Hold One Year or Less

e. Cost or other basis as
adjusted, cost of subse-

a. Kind of property and description b. Date acquired ¢. Date sold d. Gross sales - quent improvements (if f. Gain or toss
(Example, 100 shares of ‘‘2'" Co.) : (mo., day. yr.) (mo., day, yr.) price not, suenesed. qracn (4. less @.)
explanation ani . .

COR FORA TGA cco ere).

ee a
Beh ere sl leer |

¢
£
§

“2. ‘Enter | gain ‘(or ‘loss), if applicable, from line 18, Schedulo D. 7 (540) (attach copy) .
3. Enter your share of net gain or loss from partnerships and fiduciaries .
4, Net gain or loss, combine lines 1, 2 and 3

PART !!—Assets Held More Than One Year But Not More Than Five Years

6. Enter gain (or loss), if applicable, from line 20, Schedule D-1 (540) (attach copy)
7. Enter your share of net gain or loss from partnerships and fiduciaries . .
8. Net gain or loss, combine lines 5, 6 and 7

PART Iil—Assets Held More Than Five Years —

Pe. (4.78 L053. BRKYOUER |.
ers ‘Clb06s yS
ES LO

geet age

10. Enter gain (or foss), if cpplicabie, from line 22, Schedule D-1 (540) (attach copy) .
11. Enter your share of net gain or loss from partnerships and fiduciaries . .
12. Net gain or loss, combine lines 9, 10 and 11

2 a em sama aR en

we emus cen ene

PART iV—Summary of Capital Gains and Losses

13. Enter amount from line 4 .
14. Enter 65% of the amount on line 8
15, Enter 50% of the amount on line 12. .
16. Enter unused capital loss carryover from preceding taxable years (attach computation
17. Combine the amounts shown on lines 13, 14, 15 and 16
18. If line 17 shows a goin, enter here and on page 2, Part Il of Form 540 or ‘540NR
19. If line 17 shows a loss, enter here and on page 2, Part I of Form 540 or 540NR the smallest of:
(a) amount on lines 17;
(b) the taxable income for the taxable year (computed without regard to gains or losses from sale or exchange
of capital assets; or

(c) $1,000 ($500 in the case of a husband or wife filing a separate return)
NW-88426—-Boel 3245535 —-Page-188- —______—__

tal ty

-Fe.. . Reference copy, JFK Collection: H8SCA (RG 233)

°
ADDRESS

kuby. eo

——— SOC. SEC. NO.“

DEDUCTION SCHEDULE

MEDICAL STATE T FEDERAL [CONTRIBUTIONS STATE FEDERAL

MISCELLANEOUS DEDUCTIONS
30 aLimoNY
31 UNION/PROFESSIONAL DUES
32 CHILD & DEP. CARE (Furm 2441}

MEDICARE INS.
GLASSES

“2 MEDICINE/ORUGS i 4 21 PARTNERSHIP SHARE P|
3 LESS 1% AGI, (Line 18 - 1040) . GIRLIBOY SCOUTS qr]. |
4 NET MED/DRUGS _ [| HEARTFUND/CANCERFUNg [| |
5H & A INS. (% + EXCESS) _ 0 Y | Regenescunmo rune \ Las
6a DR. , ee ee XMAS & EASTER SEALS \L JF 8)

OR. Pe | j |_| MISC. ORGANIZED CHARITIES] |
OR. {sis = POLITICAL CONTRIBUTION
oR, ee ee
OR. fo [| po P|
a 4 —=
oR. a
a 22oTHER THANCASH
4 een
Gb HOSPITAL 4 | [24 ToTAL CONTRIBUTIONS > Bde
PROSTHETIC APPLIANCES iL. — CASUALTY OR THEFT LOSS(ES)
HEARING AID 25LOSSBEFORE ADJUSTMENT |__|
I — 26 INSURANCE REIMBURSEMENT
6c AMBULANCE i] | [27 difference (not less than zero) —
LABORATORIES —s 28 ($100 LIMITATION PER CAS.)
TRAVEL FOR MED. | (J UPD "a 2@ror.cas.onTHEeTLoss Df ss
—

7 MEDICAL EXPENSES
‘LESS REIMBURSED BY INS.
8 LESS 3% ADJ. GROSS INC.
9

|
i

UNIFORMS/PROTEC,. CLOTHING

Auto Use

a

| 263
+:% (TO $150) OF H& AINS._- | Las
10 TOTAL MEDICAL DED. a! &~ be
TAXES INVEST. COUNSEL & PUBS.(Sched
T1ISTATE & LOCAL INCOME
12 REAL ESTATE
13 STATE & LOCAL GASOLINE
14 GENERAL SALES TAX
15a PERSONAL PROPERTY
I5b PERSONAL PROPERTY AUTO
IGSTATE DIS.INS.H = oW

SALES TAX AUTO

“i

EMPLOYMENT AGENCY FLES

SAFE DEPOSIT BOX :

TEL. REQ. IN BUSINESS

2

|. |

7 | |

-f
mm
rere
|_| 34 TOTAL MISC. DED.
|__|

|

SUMMARY OF ITEMIZED DED. STATE
B ror. DEDUCTIBLE MEDICAL & DENTAL
PENSES (FROM LINE 10)
36 TOTAL TAXES (From LINE 17)
37 TOTAL INTEREST (Line 20)

38 TOTAL CONTR. {Line 24).
39 CAS. & THEFT LOSS(ES) (Line29)

40 TOTAL MiSCELLANEOUS
DEDUCTIONS (FROM LINE 34)

all
Pt

iY.

:
N

17 TOTAL TAXES
.NTEREST (TG WHOM PAID)
18 MORTGAGE

+

HE

19 INSTALLMENT LOANS
MERRILL ¢
TRAD +

SS BA

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Iv)

‘ n
} m
=}
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47 LOTAL ITEMIZED DEDUCTION
ENTER ON FORM 1040 LINE 45 aa

REMARKS

Nz

NOVA S¥e IESE S2245535_ Page 1Bet

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cnt eee -_ . j

a ee ee i

- ute ’ . ia
NAME L h LL tS huey NO. CALENDAR YEAR 1 OY
OR
; Pe ; Mies SOC. SEC. NO.
ADDRESS o, ‘ime en a FISCAL YEAR ENDING

19

7 SCHEDULE OF PROFIT (OR LOSS ) FROM BUSINESS OR PROFESSION
_ PRINCEPAL BUSINESS ACTIVITY
BUSINESS NAME EMPLOYERS NO.

BUSINESS ADDRESS
TOTAL RECEIPTS
mmm AAT

INVENTORY AT BEGINNING OF YEAR
MERCHANDISE PURCHASED

a

: 5
S|

P|

af |_|

LABOR ee ae
ee

a

a

TOTAL 440791 _|
|

‘

INVENTORY AT END OF YEAR

GROSS PROFIT

S

GRUSS INCOME

OTHER BUSINESS DEDUCTIONS

ADVERTISING - , | oe? |)
AUTO AND TRUCK EXPENSE | Daype-Po AT a. WY. O44 |_|
aAo DEBTS a
CASH SHORT ee
COMMISSIONS : FT

DELIVERY

|
DEPRECIATION ( SCHEDULE ATTACHED ) ; | (339 | |
: aA

QUES AND SUBSCRIPTIONS

ENTERTAINMENT AND PROMOTIONAL

|
i

tNSURANCE. 7
inven isk aan

JANITOR SERVICE
LAUNDRY
LEGAL AND ACCOUNTING

:
i
-

MAINTENANCE

OFFICE SUPPLIES AND EXPENSE
RENT
REPAIRS

S| | bid

SALARIES AND WAGES
SALARIES OFFICERS

SUPPLIES
TAXES AND LICENSES

.
96
LS

TAXES - PAYROLL

TELEPHONE
TRAVEL

UTILITIES

TARK( NG

WE

NET PROFIT OR( LOSS ) - FRDERAL RETURN

a gy oan +) Ae
NET PROFIT OR 10SS ) «- STATE RETURN ( SEE DEPREC, SCHEOULE FOR DIFF, Kw) LYOD | !

NW 883265 Decld:32285935° Page 190" '°¢ ; SCHEDULE

’

4 Lee oe : Reference copy, JFK Collection: HSCA (RG 233) i%s,.

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NW 68326 Docid:32245535 Page 191

Reference copy, JFK Collection: HSCA (RG 233)

TAXABLE YEAR. |
pte aoe grap

me

REST DEY iv

ode. VIDUAL

: CALIFORNIA
bite -

| 1972, ending

LAST AAIZ
RUBY

ra idelieg epartmaat nuc.bsr, er rurst revto)

ce
o

ZIP CODE

PATION i

occu. Yours
VWiia's

Hoeanevd«

crane ar RRR A IERIE tt LNCS ETNA TE YO AEA SSdieest “SERRE WE,
5, Brseadonts-—Do not fst yourself, your spouse or person who qualifies you as head of houcciiald :
, HAUG Cneluda tet cara and/or address If 6ifcreat from youra) AZLATIONSHIF

J sisi retain Feed, Brian, Elisa, Thomaa. ... — :
cis i ietura—Enter ‘enous! ‘6 soclal on
, Enter
tn www umber f> §
G6. Elied (refer to instructions) Number of blind exemptions claimed & 6-

27. Fetsl 6 pendent od Blind oxomptions (add lines 5 and a. .

t2 end ottech euheduly (Bos
syst (rom paca 2, ne AM.

a (from paga 2, ling 56) 2 ww ee bee ee we
; 12), Figure yeur tot on 1 thls emount by using tha a ppropriata Tox Rata

a Tox 222) Cenetule Gl g Schvulo CGS)...

Alou. .

tar icd eg “uple or head of fe uschold€59 2 0. 15 5

--Jots! en fino 7 above, Au. kB...
ud (edd Hine 18 and Le ee

) Cvbtact fing 20 from ting WP
(irom page 2, fing 89). ee
taf (subtract ling 22 from ting 21). 2 1. Cok ee et

G
pe . 24, Tax vs 1 pret ense incana (see instructions—attach Schedule pi540)) :
_3 25, Toil te te i ty tad fines 23 and 24) 2 7 2 2. ee
3 : 28. Tots) ech. fornia ‘peore ‘tex withhold (attech Form(s) W2 or GE-2P to frort) .
~ _ ah W878 ‘Catierals estinatad fad puymonts . 6 6 ee es Lone ee
: eB Bae abciale, £01 te Stok id (attach Form DE 1964 to fece of roturnl ' -
2 - _ — onsen muses pos La PETES ee =
Tote
wo af en , he Pay In full. “Mail ayment with raturn to ; flea
5 soos 0. Uf lis 3 25 Is larger th ine 29, entor CALAMCE DUE. Franchise Tax Board, Sacramento, CA 95857. ° °° * &! 30 eee
GO Buee +, ‘ ' {all retuin ta P.O, Box 13-540, oo , |
pees att tite 29 9 is lerges than tino 25, enter GVERPAYIENT. Sacramento, CA $5813, Ce
J - 3 Bt bing a to bo (a) “nerunbeo, (Atlowr at leest cl woeks for your refund) 2. | . - |
eo 7 4... (b} Credited on 1973 estimated tar. 6. ee
= see an oa eR EPS ANN A ATER IIE IRD A TPE snamiessieia mak rat errors
SF Under pacaities of perfery, | dccteza that 1 ive panied this return fatlusing peeonnanying seheduie end tloterents, and to tha best of ty bnoulees2 ond | Do Ral write tn thes
= 7 if is Gus, cerrect and come Wf prepared by a pertun other thon taxpayer, his declaration ts based on alt Information of which he hes ony teratedge.
a _ . EDWARD L. LAMBERT
£ Sh i) D> Yeur ‘igs fling Jointly, BOTH rans sign is Goer a cA ea a E
. 1 +

NW 88326 Docld:32245535 Page 192

Reference COPY, JFK Collection:

WetWZD BEVUCTIOS

fered ¢9 Perm 829

.

if on3 ssouge Itemizos éccuctions, the olker may not use tha Tox 7 c7 cla.
32 staadard duduction. [f you ehvose to Itemizo your deductions, camzcia 0
annronriata liems bolow. ; . at

Cc. .pisetions

23. Cosh—Including checks, “money orders, ete.
(iterize) a”

a rs at 1S of Caste
Fora a0 Le

poe

3. Total cech contr

“1 (tse thon cach (scp instructions). Entcr total
Ee

oe fot Leeds “a lines 23 and 24,
ms

alfa doduction

po ¢
~

ih frp
Bik 0213p 00) aR

ie)
eo

a) ROR
u foe i
Mi 1 .

29, Yet Add lines 26, 27 end 28. Enter here and
on Form 540, pas De ee

23

cua Bader a3 i

Cas or Theft ft Losslesh-29 fastrucdens

NOTE: Hf you hed more than one casualty or theft
lol. cecaitenes, omit tines 59 throught JJ and foilos
ingaucuons for ‘guidance.

35. Loss Dalora adjustments 2. 6 ee es
31. Insurance rolmbursemant . 6 6 eg eee
32. $100 fimitation © 0 6 6 wee ee Messer
93, Add Hines 31 ond 320. =. 7 1

Casualty or theft (oss. (Ling 30 fess fina 33)

5

1 sdb “é 11898 oJ ud Hunt

. RNS cvo—See instructicas . 6 2.

3. Gther—Fer education, alimony, uanlon duss, ete.
Seo Instructions _..... sesetteecssneenaese

a7, Total miscollancous Geductlons—-Add IInes 34, 35

ol rote tedeomallt ‘tires 14 ehough 20, Enter
and 36. (Entot hare and on Form 540, page Ap

. hero end on Fone £60, para dbo... ab | 2)

841,00

ay ene i

NW 88326 Dochd:32#45535 Page 193

Reference copy, JFK Collection:

ALICORRIG

SCHEDUL E

—_ PROF (621 LESS) FRAN CUSHIESS 62 PROFESSION

{Salo Prenrictorshigs) ..

7Tlo en Com é.
wanes wth

Utehab Sseu. Miiif fos. welt

mS Sm

UFOIy C8ts, Go

soe ener are ee Tarr en nN A EO NN OTN EN OAL OS OTT SET

‘ WEEE oaneene cee @ PROMUCE ee oe ee scancceseregnuneveseteotive rae
4 (far examples | retail nord WOIO: vihelssalo—tobacto; sorvices logals munulasiusing-- “furnltura; ete)
aes anshoot Bar: hk Bur cles te sue wana Cx Fodoral omployor identification numbor........---

Oy Raginess 6 ceweeeeeeee PAO VOW GUYS BAvds oo VGA NUYh, Oss]
“et ise stating: - i cash; []- ‘eccrual; a other.
SS 57 G99, B22 2 andl & fee) for the calohtcr year filed dif required)? ([] Yes {) No

boundaries of # ng ‘city, town, ote. indicated? oe

54 13 ‘Van, “Nuya Bivd. Van Nuys, Califormha i eee

boy

3 Hoemied

cnsos $.
3 (eiae chechedule) 2...

‘phan iseu Inuiructions for tina Pay ee

groraa (209 dactruciiens for ling VER)
yee” tae

= (0) Toral & other business expenses (add ‘lines 19(a) through 19(0)) toe ee .
20° ~ Total deductions (add lines 6 through 19). . . . . Cee ee ee

2 Net profit (or loss) (subtract line 20 from line 5). Enter here and on page 2, Form 540 or Form 540NR

a

NW 88326 Docid:32245535 Page 194

:

N

SEBEL MS RAPER dP ORES A

ea aA ONE

GALIFORNIA - ee
- nal GAS AND TT
a CAPITAL GAINS AND LOSSES

f FORM

s nomedule to report gains and losses on stacks, bonds and similar investments,
ere gains (but not lozses) on personal assets such os a home or jewelry.

Use thi

Seciai Security Number

Yas

ame as shown on Form 540 or 542562

Samuel and "hvilis Buby

SHORT-TERM—ASSETS HELD NOT MORE THAN 6 MONTHS

“
#. Cost or other bs sis, as

adjusted. cast of
subsequent izaroverents | f. Gain er los.
if not purchased, (d less e}
attach eaplanation)
and expense of sae

b. Date acquired c. Date sold

(mo., day, yr.) | (mo. day. yr.) 2 G: ss sales price

a. Kind of aroperty and desis
(Examate, 100 shares of "2" C3 *

| |
ee cad ni
foo fe

SCHEDULE ATTACE = |

“2. Enter your share of net short-tezm gain (or loss) from partnerships and fiduciaries

3. Enter net gain (or loss), comoire lines Tand2. 0.0. 6 8 ee ee et .
4. Enter unused short-term capita: loss carryover from preceding taxable yeors (attach statement)
5. Net short-term gain (or loss}, combine lines 3and 4. .

Enter gain if applicable from line 4, Schedule D-1 (Form 540) (attach copy) - - - - + + + rs eects ceees
8. Enter your share of net long-term gain (or loss) from partnerships and fiduciaries
9. Net gain (or loss), combine lines Eéthrough 8 2. ee es eee.
Enter unused long-term capite! joss carryover from preceding taxable years (otiach statement) . - 2 - ee 12 nA)

Net long-term gain (or loss}, combine lines 9and 10.

12. Combine the amounts shown os lines 5 and 11, and enter the net gain (or loss) here. - - se ee
13, If line 12 shows a gain— ,
(a) Enter 50% of line 11 of 56% of line 12, whichever is smaller. Enter zero if there is a lass or no entry on line 117 oe ceeeeeenee:
(b) Subtract line 13(a) from line 12. Enter here and on line 32, Form 540 (line 33, Form S40NR) 2 eee bee eee eee eee
14. If fine 12 shows a loss— a
(a} Add lines 4 and 10 (if lines 4 and 10 ara blank, enter a zero here and on lines 14{b) and 14(c) and go to
fine W4(d)) we re . we
(b) Combine lines 3 and 9—if gain, enter gain; if loss, enter zero. see et oo coeeessnnnnneecaceeeet’
(c) Enter smallest of (i) line 14(a) less line 14(b); (ii) the amount of taxable income on Form 540 or 549NR,
computed without capital gains and or losses—determine this figure via a side computation; or (ii) $1,000 | ee oe
(d) Combine lines 3 and 9—#é loss, enter loss; if gain, enter zero here and on line 14{e) and goto fine 14/F) 6) eee eres

(e) Enter smallest of (i) the mount of taxable income on Form 540 or 540NR, computed without capital gains
and or losses, less line 14£c}—determine this figure via a side computation; (ii) $1,000 ($500 if married and
filing separately); (iii) i line 3 is zero or shows a gain, 50% of line 14(d); (iv) if line 9 is zero or shows a
gain, amount on line 14/d:; or {v) if lines 3 and 9 show losses, line 3 added to 50% of line 9 Loe
(f) Enter here, and on line 32, Form 540 (line 33, Form 540NR), the sum of lines 14(c) ond 14(e)—(Do not
enter an amount greeter than $1,000)... 6. eee Soke eee

¢ 3,000,90)

Carrvover (1- 2) ($14,552.00)

“NW 88326 Docld:32245535 Page 195 fan Instructions on Bock

NW 88326.-Docld:32245535 Page 196

TAXA@LE

SCHEDULE

ITEMIZED DEDUCTIONS .

Attach to Form 540

[ FORM 540

Nama as shown on Form 540

Dhy

itemized vs, Standard Deduction—You have a choice between two deduction if one spouse itemizes deductions. the other may fot use the Tax Table cr cy
meinecs. You can either itemize your deductions of take a standard deduction as the standard deduction. if you chase to itemize your deductions, compiete >
explained in the 9° ‘) Instructions. On separate returas of a husband and wile, appropriate items below.

Vedieal and dental expenses (not compensated by insurance or otherwise) far medicine and drugs, doctors, ceatists, nurses, hospital cre, insurance
mined 303 ee
premiums for medical care, etc.

1. Ona hati (but not more than $150) of insurance premiums for medical care

2. Medicing and drugs . 1. ee ef 2 oe ceeeteee |

3. Enter 1% of adjusted gross income shown 0 on Form 540 Soe ee

4. Subtract line 3 from line 2. Enter difference ‘if less than zero, enter ret0) a

5. Enter balance of insurance premiums for medical care not entered on fine 1 2 2 6. ee ee ee Be eee!

6. Other medical and dental expenses (attach itemized lis) © © 2 6 ee Co ee eee f 6 |

7. Yotal—fadd fines 4, 5 and 6) 2 2. Co }

8. Enter 3% of adjusted gross income shown on Form 5A Soe . . Lo. en Oe. ee

9. Subtract tine B from line 7. Enter difference (if fess than gero, enter soo) ns Lo
10. Total--iAdd lines 1 and 9) . . . . em | 10 150 {iG

Child Adoption Expense

11, Total expenses paid of incurred—Attach itemized list

12. Enter 3% of adjusted gross income shown on Form 540 .
13. Subtract line 12 from tine 11—See instructions for maximum limitations .

Taxes

14. Real estate .

15. State and locat gasoline

16. General sales . a
17. Auto Jicense—Excess of registration and weight tees see instuctions a.
18. Personal property .

19. State disability insurance (SD) Employer ‘private disability ‘plans: do not quality
20. Other (specify) .

21. Total tares—iAdd ‘lines 7) ‘through 20)

Contributions
"92. Cash—Including checks, money orders, etc. (itemize)... -

23. Total cash contributions . . . 1. 2 ee ee 23 |. een a.
24. Other than cash (see instructions). Enter total here ‘ Lone .
25. Total—Add lines 23 and 24—Maximum deduction may not exceed "20% af adjusted. pinss income 2. 2 2

Interast Expsnse

28. Home mortgage
27, Installment purchases”
28. Other (itemize)

29. Total—iAdd lines 26, 27 and 28) 0 ee Ce

39. For child care, alimony, union dues, casualty losses, etc.—See instructions (itemize) ........ ....

M. Tetal miscellaneous deductions. . Cn cee ee eee em | OT $0 he:
32. Tots! deductions—{Add fines 10, 13, 21, 25. 29 and 31). Enter total here and on Form 440, page 2, in space provided .S/i 0... | 32 | 4,910 9e

Schaduln A on raveria

Pepa fi TAXABLE

Rell |
ey i (Gag Hy | 19 i
PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION |

(Sole Proprietorships)

Attach this schedule to your Income tax return, Form 340 or 540NR —- Partnerships, joint ventures, etc., must fila on Form 56.

Sneiai Security Number:

Name as shown on Form 540 or 540NR
Saruel and Phyllta Ruhy

Food Service _ product

‘For sxomple: retail hardware; wholesola—toborca; services legal, manvfocturing— furniture; etc)

A. Principal business activity

B. Business name. ... Snack Rar . cou _ wre ° S- Federal aes identification number.
Saas i ; yyw y .
D. Business location .. “541€ Van Bre WS aivd oo an “Mavs, Ca Terni a | oa Co
‘Number ‘ond steal or rural route) (City post office) “State. {Z1? code

E. Indicate method of accounting: [a cash; [1] accrual; (] other (describe) bce ce ceeee cueeene cee tttane cae tiseennssceteentteet ttneetetseegen seen

F, Was there ony substantial change in the manner of determining quantities, costs or valuations between the opening and closin=

inventories? () Yes [q No. If “yes,” attach explanation.

G. Were Forms 591, 592, 596 and 599, for the calendar year filed (if required)? [i¥es fi No

> 1. Gross receipts or gross sales $ . a Less: Returns and allowances $ .
: 2. Inventory at beginning of year (If different than last year’s closing inventory cttach [ |
explanation) . . Coe ee an re ; Do SCHED LE’

Merchandise purchased $ , loss cost of ony items with- ATTACIIED
drawn from business for personal use $

Cost of labor (do not include solary paid to yourself)

Material and supplies. . Coe ee ee

Other costs (explain in Schedule c. » .

Total of lines 2 through 6 .

. Inventory at end of this year . .

Cost of goods sold and/or operations (subtract line 8 from line 2). Coke ee

Gross profit (subtract line 9 from line 1}... a ee nen
_ OTHER BUSINESS DEDUCTIONS —

: Depreciation (explain in Schedule C-2) . .

¢ 12. Taxes on business and business property (explain in Schedule C. 1)

» 13. Rent on business property .

14, Repairs (explain in Schedule C-1) .

15. Salaries and wages not included on line 4 (exclude : any. y paid to > yourselt).

16. Insurance . 2. . .

17. Legal and professional fees .

18. Commissions... 6 we Co kk ke ee ee ee

19. Amortization (attach statement) woe. oe ee ee eee

" 20. (a) Pension and profit-sharing plans (see instructions)

(b) Employee benefit programs (see instructions) .

21. Interest on business indebtedness .

22. Bad debts arising from sales or services .

; 23. Depletion of mines, oil and gas wells, timber, etc. "(attach ‘schedule)

24. Other business expenses (explain in Schedule C-1)

g 25. Total of lines 11 through 24

» Net profit (or loss) (subiract line 25 from line 10). ‘Enter here and on pag: 2 Form 540 « or “540NR

7,350) 33

SCHEDULE C-1. EXPLANATION OF LINES 6, 12, 14, AND 24

— ee a ncaa ow lieeeseen ——————
Exnlanatlon i . 7 Explanation Amevat

‘

fiw 88328 'Docid:32245535 Page 197 oO Page

sy

Oo
i i | | TAXABLE
CALUFORRA 0

ae CAPITAL GAINS AND OSES

Use this schedule to report gains and losses on stocks, bonds and similar investments,
and gains (but not losses) en personal assets such as a home or jewelry.

°

SCH

“sy
DULE

‘ Secial Secu rity Humber

Name as shown on Form 540 or S40NR

Samuel and Phyllis Puby ; : Boo Ee i

SHORT- TERM—ASSETS HELD NOT MORE THAN 6 MONTHS

rs T
a. Kind of property and descriation b. Date acquired c. Gate sold

(Example, 100 shares of 2" Co.) (mo., day. yr.) | fimo., day, yr.)

i f. Gain or loss

dG: ns sales. price 7 (d tess e)

attagh expt tanation)
and expense of sate

os “SCHEDULE ATTACHED : ‘j 9248.90)

aan renee

ii

—— et
a of.

ha

“2. “Enter. your ‘share of net short- term gain (or loss) from partnerships ‘ond fiduciaries

3, Enter net gain (or loss), combine lines } and 2 .

4. Enter unused short-term capital loss carryover from preceding ‘taxable | years (ottach statement)
5. Net short-term gain (or loss), combine lines 3 and 4 .

LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS

7. Enter gain if applicable from line 4, Schedule D-1 (Form 540) (attach copy)
8. Enter your share of net long-term gain (or loss) from partnerships and fiduciaries . . .
9. Net gain (or loss), combine lines 6 through 8 . . . woe

10. Enter unused long-term capital loss carryover from preceding taxable years ‘(ottach statement)

11, Net long-term gain (or loss), combine lines 9 and 10 .

12. Combine the amounts shown on lines 5 and 11, and enter the net gain (or loss) here .
13. If line 12 shows a gain— ,
(a) Enter 50% of fine 11 of 50% of line 12, whichever is smaller. Enter zero if there i is a lass or no entry on line 11
(b) Subtract line 13(a) from line 12. Enter here « ond on line 32, Form 540 (line 33, Form 540NR) :
14. If line 12 shows a loss—
(a) Add lines 4 and 10 (if lines 4 and 10 are blank, enter o zero here and on fines 14(b) and 14(c) and go to
line 14(d)) . . . .
(b) Combine lines 3 and 9—if goin, enter gain; if loss, enter zero .
(c) Enter smallest of (i) line 14(a) less line 14(b); (ii) the amount of laxoble income on Form 540 or 5AONR,
computed without capital gains ond or losses—determine this figure via a side computation; or (iii) $1,000
(d) Combine lines 3 ond 9—f loss, enter loss; if gain, enter zero here and on line 14{e) and go to line 14/f)
(e) Enter smallest of (i) the amount of taxable income on Form 540 or 540NR, computed without capital qains
and or losses, fess line 14(c)—determine this figure via a side computation; (ii) $1,000 ($500 if married and
filing separately); (iii) if line 3 is zero or shows a gain, 50% of line 14{d); (iv) if line 9 is zero or shows a
gain, amount on fine 14(d); or (v) if lines 3 and 9 show losses, line 3 added ta 50% of line 9 :
(f) Enter here, and on line 32, Form 540 (line 33, Form 540NR), the sum of lines 14{c) and 14(e)—(Do not
enter an amount greater than $1,000) - So ee ee

( 1,990,00)

Carrvover (1-5) (814,552.09)

Seo tastructions on Back

NW 88326 Dochd:32245535 Page 198 . | _

KReié@rence Copy, UrK COLLECTION: Adta (Ru “vv) me te

INDIVIDUAL

CALIFORNIA

INCOME TAX

w the year January 1-December 31, 1973, or other taxable year beginning

os
SAMUEL eh Ake AY, ————_ | _—
ase 5S AM. my. a

8 PRESENT HOME ADDRESS (Number ope street, including cpartment number, or rdfol route) : "Spouse's Social | ecurly f

oe

ta

Ant

ow. A : f

ing Status - Check ‘Only “he . Exemption Credits

|. © Single . .

2 te Married 6 filing joint return

1. 2 Married filing separate return—Enter spouse's full

If line 1 or 3 checked, enter $25 |
6. Personal Exemption: [If line 2, 4 or 5 checked. enter SS STO} ...---
1. Dependents.- Do not list person who qualifies you as head of household. -

Name (include last name and/or address if different from =PRE, iogship :

“Total “Number >. oan Sees
8. Blind {refer to instructions) Number of blind exemptions P ...

3 (1 Head of Household—Enter name of qualifying
individual

5. () Widowler) with dependent child. Enter year spouse

died 19... 9. Total exemption credits (add lines 6, 7 and 8) Enter here ‘and on
; : ; ~ Attach copy 2 of Form(s) W-2 to front,
, Income 10. Wages, salaries, tips and other employee compensation Gr unavailable, attach explanation ) .

11. Dividends—before federal exclusion. Capital gain dividends must be included at 100%
12. Interest. (See instructions for taxability of federal, state and municipal bonds) .

13. Income other than wages, dividends and interest (from line 50) .

14. Total (add lines 10, 11, 12 and 13)

15. Adjustments to income (from line 56) 2 .

16. Adjusted gross income (subtract tine 15 from line 14)

@ If you do NOT itemize deductions AND line .16-is under 10,000, find tax in. Tax Table:and enter.on.tine 19.
e If you itemize deductions OR line 16 is $10, 000 or more, complete lines 17 and 18.

17. Deductions: Itemized (from line 63) OR Standard ($1,000 if fine 1 or 3 checked—$2, 000 if fine 2, 4 or 5 checked) | 17 St6 a
- 18. Taxable income (subtract line 17 from line 16) Compute tax from Tax Rate Schedule—Enter tax on line —I9 . . 18

<@ ATTACH COPY 2 OF FORM W-2 HERE >

‘19. Tax—If an averaging method is used, check appropriate box [] Schedule G, or () Schedule Gi
20. Total exemption credits (from line 9, above)
21. Tax Hability (subtract line 20 from liné 19—if tine 20 is presen than line 19, enter rerth
Your 22. Other credits (from fine 66) Lo
A and 23. Net tax (subtract line 22 from line 21—if line 22 is greater | ‘than ‘line 21 “enter zero) toe
Credits 24: Speciat tax credit—from line 75 (see Instructions, page 2, for allowat\ erédit) .
25. Net Tax liability (subtract line 24 from tine 23—if line 24 is greater thar Whee 23, enter zero) .
26. Tax on preference Income (see instructions—attach Schedule P(540))
27. Total tax liability (add tines 25 and 26) |

28. Renter's credit—if you lived in rented property on March 1, 1973, ¢omplete Part | on page 2
Your 29. Total California Income tax withheld (attach Form(s) W-2 or W-2P to face of return).

re ent 30. 1973 California estimated tax payments (include amount allowable as a credit from 1972 return) . ©. = | SOF dpe
ite 31, Excess California SDI tax withheld (attach Form’ DE 1964 to face of return). © 6 2 2 ws
32. Total prepayment credits (add lines 28 through 31) .

Ab Awad TU wervut ene ©

<4 Write serial security number on check or money order. ATTACH HE!

, 93. If line 27 is equal to or larger than line 32, enter-amount of BALANCE QUE 33
Balance Pay in full and mail with return to: Franchise Tax Board, Sacramento, CA 95867

Due 94.- If line 32 is larger than line 27, enter amount OVERPAID . . . . woe

or Mail return to: Franchise Tax Board, P.0, Box 13-540, Sacramento, CA 95813 io E
Refund 35, Amount of line 34 to be REFUNDED. (allow at least “g[x weeks for your refund) 2. we =

36. Amount of line 34 to be credited on your 1974 estimated tax... M
A

° not write in these spaces

“Under penalties of perjury, 1 declare that ! have examined this return, including accompanying schedules and statements, atid to the best of my knowledge and —
belief it is true, correct and comnlete. {f prepared by a person other than taxpayer, his dectaration is based on all information of whith he has any knowledge.

SIGN D> gen-ssencjecem ee ete beseceneengegeeeee > epee ee a

NW ww sotERG Brannawsaaeas wen eee Date Rane Cand Bip code)" Breparer’s Employer - or SSA) Number

Pog ee ea TRE ST

Reference copy, JFK Collection: SCA (RG 233) ,

GALIFORNIA

SUPPLEMENTAL SCHEDULE OF GAINS AND LOSSES

(Sales or Exchanges Including Involuntary Conversions)
(Attach to Form 540, 540NR, 541 or 565)

SCHEDULE

FORM 540

Name as shown on Tax Return
BY. EL

PART | Gain From Disposition of Property Under Sections 18211, 18212-18, 18219, 18220

Lines 9 and 10 should be omitted if there are no dispositions of farm property or farm land; or, if this form is filed by a partnership.
x ees of Sections 18211, 18212. 18, 18219, and 18220 property. (mo. day gr.)
AY. S. 5AM. a Oke... BAR eeestttesstecsseereveeee| APO | PM BL PR,

Correlate lines 1(A) through 1(D) with these columns etd jie fer |e Property

Gross sales price

Cost or other basis and expense of sale

Depreciation allowed (or allowable) .

Adjusted basis, line 3 less line 4

Total gain, subtract line 5 from line 2

If Section 18211 property:

(a) Depreciation allowed (or allowable) after applicable date.
(See. Instruction D-3)

(b) Line 6 or line 7(a), whichever is smaller

8. If Section 18212-18 property:
(a) Enter additional depreciation after 12-31-63 and before
1-1-7720.

(b) Enter additional depreciation after 12. 31 70

(c) Enter line 6 or line 8(b), whichever is smaller .

(d) Line 8(c) times applicable percentage (Instruction D-4) .

(e) Enter excess, if any, of line 6 over line 8(b)

(f) Enter line 8(a) or line 8(e), whichever is smaller .

(g) Line 8(f) times applicable percentage (instruction & D-4) .

(h) Add line 8(d) and line 8(g) .

9. If Section 18220 property:

(a) If farm land, enter soil and water conservation expenses

for current year and four preceding years :

(b) If farm property, other than land, subtract line 7(b) from

line 6; OR, if farm land, enter line 6 or fine 9(a), which-
ever is smaller (see Instruction D-5)
(c) Excess deductions account (see [nstruction D-5)
(d) Enter line 9(b) or line 9(c), whichever is smaller .
10. If Section 18219 property:

(a) Soil and -water conservation expenses made after 12-31-69

(b) Enter amount from line 9(d), if any; otherwise, enter a zero

(c) Enter excess, if any, of line 10(a) over 10(b)

(d) Line 10(c) times applicable percentage (Instruction D- 5)

(e) Line 6 less line 10(b)  . .

(f) Enter smaller of fine 10(d) or line 10(e) oo
SUMMARY OF PART | (Complete Property Columns TA) through (D) up to Line 10(f) before going to Line 11)
11. Enter amounts from line 6 ie
12. Enter amounts from lines 7(b), a(h), 9(d) ‘and 10(f)

13. Subtract line 12 from line 11, enter here and in appropriate

Section in Part Il (see Instruction D-2) oo
14, Total of Property Columns (A) through (D), line 12. Enter here and on line 24, Part If... 2... at 12.¥ -_

Page 200

N[e or on

NW°S8320—-Dochdt32245535—


Reference copy, JFK Collection: HSCA (RG 233)

>) CALIFORNIA

INDIVIDUAL INCOME TAX RETURN

RESIDENT

For Calendar Year 1970 or Fiscal Year Begun 1970 and Ended 1971
FIRST NAME(S) AND INITIAL(S) LAST NAME
Please SAMUEL AND PHYLLIS | RUBY

Type PRESENT HOME ADDRESS (Number and street, or rural route)
or. *16250 Bircher

COUNTY
Los Angeles

Print City, TOWN OR POST GFFICE STATE ZIP CODE Your occupation B
Granada Hills Califernia 91344 | Self-Employed |p—

NAME AND ADDRESS OF EMPLOYER AT TIME OF FILING Spouse's occusation _
Self-Employed Housewife

Adjusted gross income on 1970 Federal

Return s...8 ry 284.97...

NAME AND ADDRESS ON 1969 CALIFORNIA RETURN. {Ff SAME AS ABOVE, WRITE “SAME”. IF NONE FILED,
GIVE REASON.

11346 Montgomery Avenue Granada Hills, Calif. . ||f siteert tam tige 2. below, exci
Filing Status 3 Marrled, filing separate return—spouse’s name: ..

4. I | Unmarried “head of household"—Complete Part I, page 2

(check one} 2. Married, filing joint return

5. Wages, salaries, tips, etc. (before payroll deductions) if more than two employers, attach schedule
Income Employer's name Where employed (city and state)
if Joint return, veeseuseesute vu weeetaeee ewe nee fete neve tee rn ; Ce cee ne OPM be
{nclude all
Income of
both husband
i 8. Dividends. Enter total here (also list in Schedule 8 (540), Part |, if total’is over $100) 2. . . . | 6)@ 20 |60
and wife
& 7. Interest. Enter total here (also list in Schedule B (540), Part I!, if total is over $100) . 2... . Fie.
=
ual 2 .
2 8. Other income (from page 2, line 30) 2 2 2. ee 8
E
= 9, Yotal (add lines 5,6, 7 and) ee ef 9h B89 B05 [E27
tz
= : 10. Adjustments to Income (from page 2, fine 35) ee | TO
=
<x It. Adjusted gross Income (subtract line 10 from line 9) .

© If you do not itemize deductions AND line 11 is under $10,000, find your tax in Tax Table in instructions. Enter tax on line 12.
© If you itemize deductions OR fine 11 is $10,000 or more, go to Part IV on page 2 to figure tax.

r r
tor 12. Tax from (check one): Tax Table [, Tax Computation (page 2, Part IV) QQ, or Schedule G 540) Q ©. J 12 |. 51 [G0
and 43. Exemption credits (from page 2, line 43) 2 2 1 ww 13

Credits 14, Tax liability (subtract fine 13'from Une 12). 0. te ee PAY EE oo

15. Total other credits (from page 2, line 49) 2 2. 2 2. 2 ew ee ee
16. Net tax flabillty (subtract line 15 from line 14—If $1.00 or less, enter “zero”)

. 1970 California estimated tax payment or credit from 1969 (if any). if none, enter “zero” . . .

Balance 18. Balance due—If any (subtract fine 17 from line 16) . . . . . . . . . PAY IN FULL WITH RETURN | 18
Due or 19. Overpayment—If any (subtract line 16 from tine 17). 6 2 1. . . . . OVERPAYMENT | 19
Rofund 20. Portion of tino 19 you wish to apply on 197] estimated tex © 2. ee POD Lp oe

. REFUND

21. Refund—if any (subtract line 20 from line 19)

Under penalties of perjury, | declare that 1 have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and
belief it is true, correct and complete. If prepared hy a person other than taxpayer, his declaration Is based on all information of which he has any knowledge.

i
ign D> sssi-iissctae Wf ut BOTH must sign Date DP sisciirs of ‘preparer other than taxpayer

NOP D> assis singe bite gk AMIBERT-MARKELGS

56 | RA BLVD.
© Make Remittance Payable to FRANCHISE TAX BOARD—Mail to se TC KLIF. 91316

FRANCHISE TAX BOARD, SACRAMENTO, CALIFORNIA 95814,

NW 68326 Docid:32245535 Page 201

Reference copy, JFK Collection: HSCA (RG 233)

8) GAA WRINWAA—----. -_ ES

ITEMIZED DEDUCTIONS

Attach to Form 540

hee ee ee,

Ee
FORM 540

Name as shown on Form 540

Samuel and Phyllis Rub

Itemized vs. Standard Deduction--You have a choice between two deduction if one spouse itemszes deductions, the other may not use the Tax Table or claim
methods. You can either itemize your deductions o: take a standard deduction as the standard deduction. If you choose to itemize your deductions, ccmplete the
explained in the 540 Instructions. On separate returns of a husband and wife, appropriate items below.

Medical and dental expenses (not compensated by insurance or otherwise) for medicim: and drugs, docturs, dentists, nur.es, hospital care, insurance
a — premiums for medical care, ete.

1. One half (but not more than $159) of insurance premiums for medical care © 2 © ee ee ee ; 1]
2. Medicine and drugs . . . . : ee
3. Enter 1% of adjusted gross income shown on Form 540 Ce ee ee ES
4. Subtract line 3 from line 2 (if less than zero, enter zero) : ‘ Cr rr
5. Other medical and dental expenses. Include balance of insurance premiums for n adical care not
deducted on line 1 (attach schedule) Coe 5
6. Total—{Add fines 4 and 5)... . a  )
7. Enter 3% of adjusted gross income shown on Form 540 a 7
8. Subtract line 7 from tine 6 (if less than zero, enter zero) an
§. Tatal—iAdd lines 1 and 8) >
Child Adoption Expense
10. Total expenses paid or incurred—-Attach itemized list
11. Enter 3% of adjusted gross income shown on Form 540 Lok
12. Subtract line 11 from line 10—See instructions for maximum limitations Aad
Taxes
13. Real estate .
14. State and local gasoline
15. General sales .
16. Auto license—Excess of registration and weight tees tee instructions)
17. Personal property .
18. State disability insurance (§D1)—Employer orivate disability plans ‘do not quality
19. Other (specify) ve veeeteees beaten tee cree .
20. Total taxes-—(Add lines 13 through 19) od

Contributions
21. Cash—Including checks, money orders, etc. (itemize)...

22. Total cash contributions
23. Other than cash (see instructions). Enter total here

24. Total—Add lines 22 and 23—Maximum deduction may not exceed 20% of adjusted gross income wwe, a
oe

Interest Expense

25. Home mortgage

26. Installment purchases

27. Other fitemize) oo...

28. Total—(Add lines 25, 26 and 27) 2 1 6

Miscellaneous Deductions
29. For child care, alimony, union dues, casualty losses, etc—See instructions (itemize). _- cccee ceesauesensevessnese seuenuuaeueesvae eevee wees 1

30. Total miscellaneous deductions oe Lo so > 730 100] 00
on a a
31. Total deductions- (Add tines 9, 17, 20, 24, 28 and 30). Enter total here and on Forn 540. page at te space pre vided S/A. . iat ee 7kS RY

NIM BB026. Docld:32245535 Page 202 fehe dete Bone cn emetm

Reference copy, JFK Collection: ESCA (RG 233)

-PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION

(Sole Proprietorships)

AXABLE

SCHEDULE

YEAR

FORM 540

Attach this schedule to your Income tax return, Form 540 or 540NR —— Partnerships, joint ventures, etc., must file on Form 565

Name as shown on Form 540 or S40NR ial ity Nene
Samuel and Phyllis Ruby Se Gee
Food | _— ceccssecseeee-g product... . cece se sneeeeeesicees

"(For exomple: Tetall— “hardware; wholesale—tobacco; pale Segal; man. ufacturing — — furniture; ‘ete.)

A. Principal business activity...

Snack Bar k veceetsen v quesewe nae es ceeneenenees ts C. Federal employer identification number. oP 578

Van. Nuys, California 91401 00 Uw
(State) (ZIP cade)

B. Business name ..

D. Business location... 5418 Van. Nuys A Va .
(Number ond street of rural ‘route). {Clty—post office)
E. Indicate method of accounting: ff] cash; [J accrual; (J other (describe)... ecceeceueseoscneee nese ceneneseeneeseeneeastssnoncesetaaeenstememnessane
F. Was there any substantial change in the manner of determining quantities, costs or valuations between the opening and closing
inventories? ([_] Yes No. {f “yes,” attach explanation.
G. Were Forms 591, 592, 596 “and 599, for the calendar year filed (if required)? []Yes ] No

1. Gross receipts or gross sales $....-.--2-.-.--0 ---------.. Less: Returns and allowances $e eee cece | Deseecctcete cteetcet cert nrc posers
2. Inventory at beginning of year ft different than Tost year’s closing inventory attach
explanation) . rn oo .
3. Merchandise purchased $.. a vececesese ween less cost of ¢ any ) items with-
drawn from business for personal use ef. a
. Cost of labor (do not include salary paid to yourself)
- Material and supplies we.
« Other costs (explain in Schedule C. 7
Total of lines 2 through 6 .
. Inventory at end of this year . . .
. Cost of goods sold and/or operations (subtract line 8 from line 2).
10. Gross profit (subtract line 9 from line Tt ptr rte creer cretefeer cree
OTHER BUSINESS DEDUCTIONS
11. Depreciation (explain in Schedule C-2) . .
12. Taxes on business and business property (explain i in Schedule C. 7
13. Rent on business property
14. Repairs (explain in Schedule C- 1). .
15. Salaries and wages not included on line 4 (exclude « any y paid 10 ” yourself)
16. Insurance . :
17, Legal and professional ‘fees .
18, Commissions .
19. Amortization (attach statement) .
20. Retirement plans, ete. (other than your share) .
21. Interest on business indebtedness .
22. Bad debts arising from sales or service. .
23. Losses of business property (attach statement) . oo
Depletion of mines, oil and gas wells, timber, ete. (attach schedule) .
25. Other business expenses (explain in Schedule C-1)
26. Total of lines 117 through 25
. Net profit (or loss) (subtract line 26 from line 10). Enter here ‘and on page 2 2, Part i, Form 540. or '540NR

CaNaus

X)
S

Amount

NW) 828326 Docld:32245535 Page 203 . , Pans 1

Reference cépy, JFK Collection: HSCA (RG 233)

> -eaLiEORIa—

SALES OR EXCHANGES OF PROPERTY

Attach to Form 540 or 540NR

rz
e
r
¥

FORM 540

ecurity Num

Name as shown on Form 540 or S40NR
Samuel and Phyllis Ruby

Part |I—-CAPITAL ASSETS
SHORT-TERM—ASSETS HELD NOT MORE THAN 6 MONTHS
f. Cost or other basis,

- e. Depreciation atfowed cost of subsequent
a find of property {if necessary, b. Date acquired | c. Date sold @. Gross sales price (or allowable) improvements (if not
details not shown below) (mo.. day, yr.) | (me., day, ¥7-) (attach schedule) eeplaastions sed

expense of sale

9. Gain or loss
(d plus e less f)

LE ATTACHED 0 fo (15274600)

“9. Enter your ‘share of net short-term gain (or, loss) from ‘partnerships and fiduciaries
3.-Enter unused short-term capital loss carryover from preceding taxable years (attach statement)
4, Net short-term gain (or loss) from lines 1, 2 and 3

LONG-TERM—ASSETS HELD MORE THAN 6 MONTHS
5. Enter gain (if any) from line 16, Part It Sn

6. Enter your share of net long- term gain (or loss) from partnerships and fiduciaries . Coe ee Fe
7. Enter unused long-term capital loss carryover from preceding taxable years (attach statement)
8. Net long-term gain (or loss) from lines 5, 6 and 7

(15,274.00)

9. Combine the amounts shown on lines 4 and 8 and enter the net gain (or loss) here
10. If line 9 shows a GAIN, enter 50% of line 8 or 50% of line 9, whichever is smaller. (Enter zero ‘it there i is a
loss or no entry on line 8) . . . Ce ee ee fe
11. Subtract line 10 from line 9, Enter here ond | on ‘line 17, Part it
32. If line 9 shows a LOSS, enter here and on line 17, Part II! the smallest of the following:
(a) the amount on fine 9; (b) the amount of taxable income on Form 540 or 540NR, computed without capital

gains and losses; or (c) $1,000 Carryover Loss (14,274.00). ( 1,000.00)

Part 1I-SALE OR EXCHANGE OF PROPERTY UNDER SECTIONS 18181--82

13. Enter gain (if any) from line 22, Part IV. 6 ee
14. Enter gain (if any) from line 25, Part IV Loe ee ee

13. Enter your share of gain (or loss) of Section 18181-82 items from partnerships and fiduciaries
16. Net gain (or loss). If GAIN, enter on line 5, Part |; if LOSS, enter on line 29, Part V

PART ill-TOTAL NET GAIN OR LOSS FROM SALES OR EXCHANGES OF PROPERTY

17. Net gain (or loss) from line 10 of 11, Partd 2 6 we ee

18. Net gain (or loss) from line 31, Part IV tok

19. Total net gain (er loss)~Combine lines 17 and 18, Enter here ond on Form 540 or Form 540NR, poge 2, Part
Il, line 23 . : eee ees See ee

NW 68026) Docid:32245535 Page 204 Schedules cantianed ar rave. cal ; ooo » Pane I

ate, 2 wee : ~

Daa ~~ -—

SCHEDULE € -- SHAREHOLDERS SHARE OF INCOME AND CREDITS
(If additional space is needed, attach schedule)

am 0 2)
Name and Address of Each Shareholder ; . . Social Security

T . Dope ee

PAGE 4

: ESCA (RG 233)

JFK Collection

Reference copy,

. eed a ad

- SCHEDULE E -- SHAREHOLDERS SHARE OF INCOME AND CREDITS -
{If additional space is needed, attach schedule)

ee - —

(1) . (2)
Sociat Security

Name and Address of Each Sharahoider
. Number

© a). GEORG... LUA ELMS ccc cccpetseseteteesceseseneeeas

. 30 AVA GALbENs DR NMA) q 35/6
(b) 0. EPR. BIB oo cccccenesscsepersceserenei ny tree
Y3fo S70 Cree DR. Ret ols Ham. Mich Yolo

Number of
Shares

HSCA (RG 233)

JFK Collection

erence copy,

Le F -— SIAR EN OLOEARS SHARE Ge iNCGiViE ANU Caduiis

(if additionai space is needed, attach schedule)

. (1) (2) (3) (4)
Name and Address of Each Sharehoider Social Security Number of Amount taxable as ordinary
Number Shares. income (schedule K, total of
- : lines 4 and 8, US. 1120-S)
{a}. Coa 4 aa - ne ae, '
PPPS z
spar) dhySO CHICAGO TL. &

is) (6) (7) en)
Distributive Income from Amount to be used by share- Enter here and on form Enter here and on form
page 1, line 5, or page 2, hoider on M1-1040 (enter on MI1-1040, page 1, line 22 M1-1040, each shareholder's

schedule B, line 6 page 2, schedule 1, line 34 or
on page 2, schedule 2, line 43)
difference between column 4
and column &

{See instructions)

NW 68326 Docid:32245535 Page 207

each shareholder’s pro- proportionate share of Single
portionate share of per- business tax paid.

sonal property . taxes (See instructions)

paid on inventories or :
the credit for franchise
fees paid.

{See instructions)

: HSCA (RG 233)

JFK Collection

Reference copy,

SCHEOU

a

fae)
Name and Address of Each Shareholder

(5)
Distributive Income from
page 1, line 5, or page 2,
schedule B, line 6

LE & — SHAAETOLDERS SFIARE OF INCOME AND CRIS

(If additional space is needed, attach schedule)

(6)
Amount to be used by share-
holder on MI-1040 (enter on
page 2, schedule 1, line 34 or
on page 2, schedule 2, line 43)
difference between column 4
and column S
(See instructions)

(2)

Social Security
Number

(3)
Number of
Shares

(7)

Enter here and on form
MI-1040, page 1, line 22
each shareholder’s pro-
portionate share of per-
sonal property taxes
paid on inventories or
the credit for franchise
fees paid.
(See-instructions)

- (4)

Amount taxable as ordinary
income (scheduie K, total of
lines 4 and 8, U.S, 1120-S)

a t

19 7 30./6

(8).

here and on form

each shareholder's

proportionate share of Single
business tax paid.
(See instructions)

.

a) 19,7306 | 4b)

(b)}%, 30.18

4é6.c!

Sia Tn

{c)

(d) . ; ;

NW 68326 Docid:32245535 Page 208

‘JFK Collection: SCA (RG 233)

Reference copy,

nant a Aro

0-1040 (NR)

CivY OF DETROIT INCOME TAX
CITY OF

INDIVIDUAL RETURN —|NONRESIDENT

1976

DETROIT

or other taxable year beginning we

+ 1976,

ending .

wy WG. |

First Name and initial

Earl R. and Marge

Last Name

Ruby

Your Social Security N ‘Number —

1

Your Occupation

if you are an EMPLCS

EXTENSION NUNBE!

BSCA (RG 233)

PLEASE (If joint return of husband and wife, use first names and middle initials of both) Sales enter your Federal EMPLO

PRINT | Home Address (Number and Street or Rural Route) - - - Identi ieation No. her¢:
OR . . Spouse's Social Security Number

tyre | 18135 Livernois '

City, Town or Post Office
Detroit,

State

Michigan

Postal Zip Code

48221

A. If married, is spouse filing @ separate return? (] YES

B.
moved.) If none filed, give reason.

Same

YOURSELF «ww ww
SPOUSE . 6. ew ee ee ee

SCHEDULE A— EXEMPTIONS

Oo

1
‘

NAME ;
Enter figure 1 in the last column to
tight for each name listed

Enter the name and address used on your return for 1975 (If the same as above write “Same”.

Regular

b f
qJ O oO xem ptions
na oO oO checked

Spouse's Occupation
Housewife

lf different, indicate date

JFK Collection

Auditor

Entef

65 or over Blind

Enter ‘ 9.

Months lived in
your home during
1976

Relationship

OTHER
DEPENDENTS

Reference copy,

4. Total exemptions from lines 1, 2 and 3; enter here and on tine 15 below.

TOTALS

Attach Copy of Form DW-2 or W-2 Here

2 2 ND

2

Net profit (or loss) from business — from page 3, Schedule C, line 8

qd 0

17. CITY OF DETROIT TAX: Multiply line 16 by .005 (%%)
PAYMENTS AND CREDITS

18. a, Tax withheld by employer — from line 6 above — ATTACH Forms DW-2 or W-2
b. ‘Payments and credits on 1976 Declaration of Estimated Detroit Income Tax

¢, Other Credits — explain in attached statement (See Instructions) ..

19, | TOTAL — Add Lines 18a, b, and ¢

Gain (or loss) from sale or exchange of tangible property in the City of Detroit — from page 3, Schedule €, fine 10.

12. Total (add lines 6 through 11 of last column) 66... ee

13, Less: Deductions from page 2, Schedule M, line 5 (if none, enter zero)

14, Total (line 12 less ine V3) eee need
15. Less Amount for Exemptions: Enter number of exemptions from line 4 above

16. TOTAL INCOME SUBJECT TO TAX

INCOME (if joint return, inciude all income of both husband and wife) :
5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. — indicate (W) for wife :
Total wages reported Detroit Income Tax WAGES, ETC.. EARNED
Employer's Name Where employed (City and State) on DW-2 or W-2 Withheld IN DETROIT
Cobo cleAvers -tve. Deter 7, Mien. |. (64220 09 15. 770b9 | 212902...
Coao -Rurng SALES, Tue. DE7kOIT, Much. | te, Seeios 0 108 8 250108

—y2ko.oe |. _ 90, 35222.
Rental income (or loss) from tangible property in the City of Detroit — from page 2, Schedule B, line 4
Other income (or loss) from partnerships, etc, — from page 2, Schedule F, line 4.........

O37.

: Income ( (or loss) —~ TRUSTS AND ESTATES ONLY — from page 4, Schedule G, line 7 (see instructions for.exemptign to enter on line 15)

Joc AD FED 22.
s__{p200,90 |
G+ 2G2172

t713 |

ch Check or Money Order Here

TAX DUE OR REFUND

20.
21.

22.

D Atta

If your payments (line 19) are larger than your tax (line 17), enter amount of
Check box if you wish overpayment on line 20 te be: (A) (0 Credited on 1977 Estimated Tax or (8)

OVERPAYMENT

Refunded.

If your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this return.
Make check payable to: "TREASURER, CITY OF DETROIT.” A balance due of less than ene dollar ($1.00) néed not be paid.

I declare that | have examined this return {including accompanying schedules and statements) and to the best of my knowledge and belief it is true, correct and
complete. if prepared by a person other than toxpayer, his declaration is based on all information of which he has any knowledge.

SIGN
—— > | SIGN HERE
HERE

SIGN weve Y

OS. cere t

NW 88326 Docid:S¥S45595 FinggeezBgrert

(Spouse's signature and date) (if joint return, BOTH HUSBAND AND WIFE MUST SIGN)

OCTIIDAIC aster PE fire nv anni AAm

CERTIFIED PUBLIC RCCOONTANT
ment, Treasury Division, 104 City-County ROGID GVESTrS EN ila ROARS

mis ee

Mich. Dupt., oF Treasury i enn ee ee ee ee A er ey
: 1

” ~NN j Balaacta-i a oe 1 em na es Bh
BeOgO8K oo Scuecuie of Partners or Sharenolders— i876 c
Parinersiip, Subshapter $ Corp., Professional Corp.
See instructions on reverse side
1 Name: 2 Account Number:

i

Cobo-Rumar Sales, Inc. 38-1812707
PAR ; SUMMARY :
3 Total Number of Partners or Shareholders... cece cceeeeteetet tetera: —o
4 Total Number of Qualified Partners or Shareholders from Part I|—enter here and on C-8000, line 60a... | 4 |
Lagi ail QUALIFIED PARTNERS OR SHAREHOLDERS , :
A NAME AND ADDRESS B SOCIAL CG % | D SHAREHOLDER’S PARTNER’S or SHAREHOLDER’S

te

SECURITY NO. Time} SALARY F Share of Bus. Inc. | G Share of SBT Paid} .

|< Earl Ruby ; ;
4380 Stoney River; Birm. | @RZMBZMMR }100,| 18,000 | 001100 | 00 00
| ; a a

00. | | 60

00 00

08 | 00
00 | 00 |.

— fh ol x joo} | 00
pe Fi

i

PAR Hal NGN-QUALIFIED PARTNERS OR SHAREHOLDERS, If more space is needed submit separate schedule and enter totals on line 7.

UT

il

NW 86326 ("Hop xiéyg 4 ign 1PBaep” be I) 7 00 Zz , ron nn

JFK Collection: SCA (RG 233)

Reference copy,

: PAWL bees Ee ; fe :
Calendar Vear 19 7G THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPON( _ 2
OR FISCAL YEAR } o

I . tal
Beginning 19 ; 7 ON
Ending Po ronormceuseomy |
Bx INDIVIDUAL (Check: ; a
[J FIDUCIARY — one) RUBY EARL & MARGIE 6988 5, 9
18135 LIVERNOTS AVE mo ‘a
DETROIT MI 48221 “
Husband's Social Security No. aay
Se. See:
i}
uv
Mo. Day Yr. Wife’s Sociat Security No. 4
09 30 76 698855 8
Retroactive Date Intangible Account Number 76 ohne’
# this return is for an Estate. give Probate. SoD: <arreDs Employer Identification No. Fa
;

m
o°
LINE LINE v
“ Computation of Tax Due AMOUNT TAX o
1. Accounts and Notes Receivable (non-income producing only) 1 Ky
2. Less Accounts and Notes Payable 2 4
3. Balance Taxable @ 1/10th of 1% 3. “4 —
4. Accounts and Notes Receivable (income producing only) 4. a
5, Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2) §
6. Balance Taxable 8
7. Income applicable to balance 7
8. Tax @ 3%% of income (Line 7) or 1/10th of 1% of Balance (Line 6), whichever is greater. | 8.
9. Stocks and Bonds - - - - - Schedule A, Column 9. . 9.
10. Mortgages and Land Contracts - - - - - Schedule B, Column 8. —
11. Annuities - - - - - Schedule C, Column 9. 11,
12. Beneficiary Return (attach copy hereto) 12.
13, , TOTAL

14, : Less Statutory deduction ($175.00 or $350.00 by husbands and wives filing joint return)
15. BALANCE DUE

16. Cash on Hand or in Transit as of retroactive date (include cash in safety deposit boxes)

17. Bank Deposits in Banks Located Outside of Michigan ______»—=ss {or Withdrawn from Mich.

Banks or Ass’ns. after
18. Savings in Building and Loan Ass‘ns. Located Outside of Michigan RETROACTIVE DATE.
19. TOTAL

20. TAX @ 20¢ per $1000.00 of Line 19

21, TOTAL TAX DUE (Line 15 pilus Line 20)

22. . Less Advance Payment of Tax

23. . TOTAL TAX DUE

24, Penalties & Interest; Penaity %, S___.___; Interest _____ % __ Months, S.

28. TOTAL AMOUNT OUE WITH THIS RETURN (Due on or before April 30)... ee beeen eee an ees
Or Four Months after End of Authorized Fiscal Year

Make Remittance Payable To: “STATE OF MICHIGAN’ Write your Intangible Account No. on your check,
Mail To; MICHIGAN DEPARTMENT OF TREASURY, TREASURY BUILDING, LANSING, MICHIGAN 48922

Business or Profession of Taxpayer: Amount Singie Business Tax Paid: Single Businass Tax Account No.; Telephone Number:
SALES : §63. 0400

Year of Last Return Filed: Address of Last Return:
-
1998 GAME

Check which Method: your return is Computed by.
[X] RETROACTIVE DATE [[] MonTHLY AVERAGE

“| NOTE: if this raturn ts from a Trustee, attach a list of Names and

Addresses of Beneficiaries and Date of Creation of Trust.

| declare under the panattins imposed by Act No. 301 P.A. of 1939, as Amended,

fiat this rating, dneheing nny ndeemnpanying eehortdes ated slalamenta has lean . :

earned by ma aad to the best of my kaowlelye end belief ia a tua, correct Signature — a — cmon —
and complete return. .

Prepared By: 0 ON L, HOLLANDER; PC: Signature

CERTIFIED PUBLIC ACCOUNTANT ;
NWS aR Dini: 24S WY PEG CTE MEE-ROAD

vn Title: (State whether Individual, Owner, Executor, Administrator, Trustee, etc.) :


ne

MICHIGAN INDIVIDUAL INCOME TAX RETURN

for 1975, or taxable year beginning
Y First name and initial (if joint return, use first names and initials of both)
Earl R. and Marge

Home address (number and street or rural route)

18135 Livernois Sales

, 1975, ending ——______-__, 19

Your social secu

Last name

Ruby

Your occupation

wo ne? eee eases social Security tO
= City, town or post office, and State : ZIP code Spouse's social security no
3 Detroit, Michigan ~ 48221 ; | |
= Residency Status during tax year: : Spouse's occupation
. Resident CT Non-resident | Part-year resident, from ____—- to
§ © Filing Status: 1. Exemptions: :
= A CiSingle (a) Enter here the number of exemptions claimed on your
B Ca Married, filing jointly federal income tax return... 0.2.00... e eee eee _ 4
¢ (Married, filing separately (see instructions, page 2) (b) Special exemption for paraplegics & quadriplegics . [instructional
a Name of Spouse —————_____________ (c) TOTAL EXEMPTIONS, add lines 1(a) and I(b)............--- @O_ 4+.
(Give spouse's Soc. Sec. Nao. in the space provided)
2. STATE Do you wish to designate $2.00 of your taxes for this fund? 2) . COYes &) NO NOTE: you creck ne eS ae oF
CAMPAIGN FUND \f joint return, does your spouse wish to designate $2.007..... Dyes i NO reduce your refund.
Vv 3. Adjusted gross income as defined in the Internal Revenue Code and which should be reorted on Federal Form 1040,
. . ttach copies of any Federal schedules that-indicate-a loss or deduction
2 line 15, or 1040 A, line 12 trom gross income. (See page 5 of the instructions) .......-- eee eens
2 4. Additions to adjusted gross income, (from page 2, line 1)
= 5. Total, add lines 3.and 4.0... ee ee eee resets .
e 6. Subtractions from adjusted gross income, (from page 2, line 44)............... eee
(2 7. Subtract line 6 from line 5.00... eee tere eer rere es ses wee TD
Ss 8. Residents multiply exemptions claimed on line 1 by $1,500.00 (part-year and nonresident allowance from line 48) ... @
3 G. Income subject to tax (subtract line 8 from line 7)... 06.6... - eee eee ttt tenes
@ 10. Tax: multiply line 9 by 4.37% (0437) 00 ee te ert teens rrr vs
s CREDITS (See instructions - pages 7-10) AMOUNT PAID CREDIT
S11. Income tax paid to Michigan cities... ... Soc eevetvans @ ice) Ha. Aqo
2 12. Contributions to Michigan colleges & universities (attach receipts). @ 12a.
13. Income tax paid to another state (attach copy of return)........ 13. ©.
14. Total credits (add lines 11a, 12a, and 13a), enter total here... 66... ee ene eee tee ete tne 14. 20/04
15. Income tax, subtract line 14 from line 10 (if line 14 is greater than line 10, enter ‘NONE’)).........-...--j 000s Oo. 497184
16. Credits from any MI-1040 CR form. (see page 9 of instructions). .....--..+--.- +++ +++ 6) ts
Do not complete lines 17 thru 21 if you have claimed a credit on line 16. :
17. Household income from line 56.0... 2... . eee eee eres @
18. Enter 1975 homestead property tax or amount from line 59 ..... ©
v 19. Tax not eligible for credit, enter 3.5% (.035) of line 17......... 19.
w» 20. Subtract line 19 from line 18, if line 19 is greater, enter ‘NONE’ .. 20. ; :
21. Property tax credit, 60% (.60) of line 20, ($600.00 maximum)... 2... 0. ee eee ee 21. —
35 22. Personal property tax paid on inventory. @ _ 39% (.39)........ 22. Z
S PAYMENTS ;
3 23. Michigan tax withheld (attach State copy of W-2).......--.- ccbeceetueeetevesees @ AIS |SO
= 24. Michigan estimated tax payments............... Oo ccvedeeeeeettveeessenees @ f, 090] 00
S 25. 1974 overpayment credited 10 1975.... 0... ec e eee eee eee e eee ee (75) . . .
B26, Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25.......... +. re rere 8. G, 15750
S 77. it line 26 is less than line 15, enter BALANCE OF TAX DUE HERE............. Slices ecceeee PAL @ 240 |3
S28. If line 26 is greater than line 15, enter AMOUNT OVERPAID. ....-... 2... 0. sees ve reer rec rees gee 28.
= 29. Amount of line 28 to be REFUNDED TO YOU... 2.00.0... 0002s occ escent ens REFUND » @ . .
30, Amount of line 28 to be credited to 1976 estimated tax...... @—__|_ — NO a ot ayo itty on line 20,
fe)

This return is due April 15, 1976 or on the 15th day of the fourth month after the close of your tax year.
Under penalties of perjury, | declare that t nave examined this return. including accompanying schedules and
statements, and to the best of my knowledge and belief it is true, correct and complete. If prepared by a person

other than the taxpayer, his deciaration is based on ali information of which he has any knowledge.

Sign PP vows ae baie FORBUN't HOL CANBER™B'c. ce 2 ate

NW S88B8 Socld:32245535. Page, 242 aor aust sign even if cnty one had income) CERTIFIED PUBLIC: ACGQUNTANT:

AAFLIF WIPE Prat bat AAA

JFK Collection: SCA (RG 233)

Reference copy,

tore a reine m1 ¥/6
2 > Exemptions (number of allowable exemptions times $1,500.00).... 0.0... eee
3. Subtract line 2 from line 1. (This is your estimated taxable income} an bbe eee
4. Estimated tax (line 3 times .046 or 4.6%). . nen
5. LESS: Total estimated tax credit for Michigan city income taxes, personal property tax on inventories, j
Michigan homestead property taxes and contributions to Michigan colleges and universities ne ‘
6. Subtract line 5 from line 4. Enter here and online | below............. beets

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS— 1 976

FORM

Ces
michigan, MI-1040-ES

ity

| For calendar year 1976 or fiscal year ending ——_—___________., 19___. STATE OF MICHIGAN
. Department of Treasury

Address (number and street)
City, State, ond ZIP code

Your estimate of 1976 income tax... enn :
Estimated income tax withheld and to be withheld during entire year of 1976... 00... .5 0.00.0 c ee eee , \
ESTIMATED TAX {line I less fine 2). (If tess than $100, no declaration is required)... 6.06...

COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.

If this declaration is §(JApril 15, 1976, enter 1/4 of line 3; [“] September 15, 1976, enter 1/2 of line ‘t
due to be filed on: one 15, 1976, enter 1/3 of fine 3; (CT) Jan. 15, 1977, enter amount on line 3 .
If you had an overpayment on your 1975 income tax return which you elected to have applied as a [| ‘ cs
credit against your 1976 estimated tax, enter the amount here........ 0.020.000.0000 0 eee eee 7 a
To apply entire overpayment crédit to this installment and any excess to the next, enter here the amount on line 5. To spread
credit evenly.to each installment, divide it by number of instaliments and enter results here... . 2... eee eee eee
. Amount to be paid with this declaration at time of filing (line 4 less line 6)..........-- Fee ee

Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing of
quarterly estimates. Enter lump sum payment here.............

barat
vent
sat

Your social security number

First name and initial (if joint declaration, use names and initials of both}

Please
print
or type

Spouse’s social security number

mB wne

wn

a

co ™

| have examined this deciaration and to the best of my knowledge it is correct. : :
SiQnaturelS) .o..ccccceccscccccssegeceneesestensesce casescen esesseostsaeusnsseusncerseeneeeeeeascesecsceetsossereaeease Date... cescsseeceecseeeeeeenceeeeesee 19

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS— ] 976

For calendar year 1976 or fiscal year ending —__________, 19___ STATE OF MICHIGAN
‘ Department of Treasury

FORM
MI-1040-ES

“anergy

se 14
Alert
First name and initial (if joint declaration, use names and initials of both} Last name .

Address (number and street)

City, State, and ZIP code
Detroit, Michigan 48221

Your social security number

Please Spouse’s social security number
print

or type

-1. Your estimate of 1976 income tax. nee $1,609 09
2. Estimated income tax withheld and to be withheld during entire year of 1976 ©. : :
3. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)................ i 3600-909 |
4. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.
if this declaration is aio 15, 1976, enter 1/4 of fine 3; [JSeptember 15, 1976, enter 1/2 of line 3) ...... cece ot 99 92
due to be filed on: { June 15, 1976, enter 1/3 of line 3; ([CJJan. 15, 1977, enter amount on line 3 }

an

_ If you had an overpayment on your 1975 income tax return which you elected to have applied as a
credit against your 1976 estimated tax, enter the amount here.......... De cv cee v te erv ees
. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To
spread credit evenly to each instaliment, divide it by number of installments and enter results here... a caseeecsenaneeeeaeceseee ee
7. Amount to be paid with this declaration at time of filing (line 4 less line 6).... 0.0.2.0... occ eee ], 00-00
8. Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing
of quarterly estimates. Enter ump sum payment here... 2

NW Basen’ Baars 2949595" *paywa'tsr best of my knowledge it is correct.

fost

Nate . ..19

JFK Collection: 8SCA (RG 233)

Reference copy,

p040(N)” CITY. OF DETROIT INCOME TAX “1975

=
TY OF m
eTROIT INDIVIDUAL RETURN — [NONRESIDENT] _
D ‘ or other taxable year beginning... oe 1975, ending ... ig
First Name and Initial . - Last Namie Your ur Social EXTENSION NUMBEL ~~ |
. an
Earl R. and Marge _ Ruby _ 3
. . + eoege lf you are an EMpigs
PLEASE (If joint return of husband and wife, use first names and ‘middle initials of both) enter your Federal EMPLO 2
PRINT | Home Address (Number: and Street or Rural Route) Identification No. here:
OR .
type, | _ 18135 Livernois a*
City, Town or Post Office : . State Postal Zip Code wd
: : 5
Detroit, Michigan 48221 v
a 7
A. If married, is spouse filing a separate return? (1) YES Kt NO. if yes, enter spouse's first MAME... ieee ves é
 cceensvsssgseveshansetenassssaaseensansvassenaneseveceetsneaseeisetuasesaseeeueneceeussseitanienacettcetaaottnie w
B.° Enter the name and address used on your return for 1974 (if the same as above write “Same”. ‘If different, indicate date 4

. ‘ . Regular 65 or over Blind Enter '
' SCHEDULE A— EXEMPTIONS 1. YOURSELF 6 ee ee nd oO o chemations

oa - . SPOUSE . 2... 1 eee ee ial Oo o :
2. Enter first names of each of your DEPENDENT CHILDREN who lived with you: Enter i

Attach Copy of Form DW-2 or W-2 Here

Qo 9 Gain (or loss) from sale or exchange of tangible property in the City of Detroit — from page 3, Schedule E, line 10

Oa 11. Income (or loss) —TRUSTS AND ESTATES ONLY — from page 4, Schedule G, line 7 (see instructions for exemption to enter on line 15);

Attach Check or Money Order Here

<> 22. if your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Pay in full with this return. © 1$.....ccc essences

moved.) If none filed, give reason. Same

Auditor

checked

Reference copy,
a

Denise, Joyce —-~ _
Months fived in
Enter figure 1} nN ane last column to Relationship your home uring.
3. OTHE tight for each name listed .
THER
DEPENDENTS ——e | _
4. Total exemptions from lines J, 2 and 3; enter here and on line 15 below. = : 4
INCOME (If joint return, include all income of both husband and wife) ~
5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. — indicate (W) for wife : :
Total wages reported Detroit Income Tax |] WAGES, ETC, EARNED. ;

Employer's Name Where employed (City and State) - on DW-2 or W-2 . Withheld IN DETROIT
Gono, Se EAvers . “DE _ 35,000 joa

2 3S ‘sar"

& TOTALS 06. eee teens
7. Rental income (or loss) from tangible property in the City of Detroit — from page 2, Schedule B, line 4.06... beet ttnteneen ete

8. Other income (or loss) from partnerships, etc. — from page 2, Schedule F, line 4

10. Net profit (or loss) from business — from page 3, Schedule C, line 8 2.6.6... ieee ee ee eet tee eee

12. Total (add lines 6 through 11 of last column) .
13, Less: Deductions from page 2, Schedule M, line 5 (if none, enter zero)
14, : Total (line 12 less fine 13) ... Lake b ee tebe eee tenes e nye ens vce pene eee ert ene , Lees Rea iche dente
_ 15. Less Amount for Exemptions: Enter number of exemptions from line 4 above oo... ut srenteereiae and multiply. by $600, bene ce eae $. A, Feo CO
16. TOTAL INCOME SUBJECT TO TAX 000 nee en eben eres 43 754 1 13
17. CITY OF DETROIT TAX: Multiply line 16 by .005 (14%)... o.oo ee els AS 7D
PAYMENTS AND CREDITS _ - '
18 a. Tax withheld by employer — from fine 7 above — ATTACH Forms DW-2 of W-2... 0.000000 beeen eee eee Soe 3 F702
b. Payments and credits on 1975 Declaration of Estimated Detroit Income Tax ©0222... 0-20 e ee cee eee ete OW ccccccecesssssteecsasasecsesbeesceseveess
«. Other Credits — explain in attached statement (See Instructions) 2.0.00... 0. eee Lecce eee nea ee ee
19. TOTAL — Add Lines 18a, b, and ¢ eee eer aera e eee eeeteee ejs____ BBO

TAX DUE OR REFUND

. . . '
20. If your paymenis (line 19) are larger than your tax (line 17), enter amount of OVERPAYMENT ........---050-5- . Sool 2012 2.
21. ‘Check box if you wish overpayment on line 20 to be: (A) (] Credited on 1976 Estimated Tax or (B) K Refunded.

Make cheek payable to: “TREASURER, CITY OF DETROIT.” A balance due of less than one dollar ($1.00) need not be paid.

I declare that | have examined this return (including accompanying schedules and statements) and to the best:of my knowledge and belief it is true, correct and

SIGN complete. If prepared by @ person other than taxpayer, his declaration is based on all information of which he has any knowledge.

——»> | SIGN HERE

HERE

NW 88326| son sti Monae


re. es

arty

ee gk tMemounn THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONC i
INTANGIBLES TAX RETURN | oe
Calendar Year 19. ; : °
OR FISCAL YEAR —_ | %
Beginning 19 l-~-------~-------~--------- DO NOT WRITE ABOVE THIS LINE---~—-——-—-~~-~-~~---~ a
Ending 19 RUAY EARL & MARGTE 69 RASS a
one Is135 LIVERNOTS AVE
Michigan Corporation Check 9 E TRO I TM I 48 e e 1 a
One o-
Foreign Corporation ‘3
Fiduciary Y JF THIS RETURN Is FOO
. ESTATE GIVE PROBA
MONTH DAY YEAR | . County . 3 _
11) 30} 75 698855 an7| 82 { 75| 12> ‘ite No. Oo
_RETROACTIVE DATE ACCOUNT NO, | vee | county | cry | x | ic | FILE DATE Date of Death i =
= 5h =
tm. Computation of Tax Due Fi TA
. cal
+, Accounts and Notes Receivable (non-ineonte producing only | {| [| | | 1 S
2 a ee ee ee OL
. Less Accounts and Notes Payable. ee . 8
3. Balance Taxable @ 1/10th of 1%. ee ee 3. . u —_—
4, Accounts and Notes Receivable (income producing only). ee 4, e
5. Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2). rT rd 5. ; v
6, Balance Taxable - —+—_}+— 6. a be
7. tncome applicable to balance. 7.
8. Tax @ 342% of income {Line 7) or 1/10 of 1% af Balance (Line 6), whichever is greater. : 8.
9. Stocks and Bonds----- Schedule A, Column 9. 9.
10. Mortgages and Land Contracts wees Schedule B, Column &.. - 0.
11, Annuities ---- - Schedule C, Column 9. |
12, Beneficiary Return (attach copy hereto) .
13. TOTAL
14. Less Statutory deduction ($175.00 or $350.00 by husbands and wives filing joint return) _ : 14, —
15. BALANCE DUE 15. i
16. Cash on Hand or in Transit as of retroactive date (include cosh in safety deposit boxes) 16,
17, Bank Deposits in Banks Located Outside of Michigan | or Withdrawn from Mich. 7,
: . Banks or Ass‘ns. after
18. Savings in Building and Loan Ass‘ns. Located Outside of Michigan_____ RETROACTIVE DATE. 18.
19. TOTAL a
20, TAX @ 40% per $1000.00 of Line 19, ot |_| .
2. TOTAL TAX DUE (Line 15 plus Line 20) ai.
22. Less Advance Payment of Tax 22.
23. TOTAL TAX DUE 23.
24. Penalties & Interest; Penalty %, $. - Interest. Yo, Months, $. 24,
25, TOTAL AMOUNT DUE 25.

MAKE REMITTANCE PAYABLE TO STATE OF MICHIGAN

Please forward Remittance for Amount Shown Here
To: MICHIGAN DEPARTMENT OF TREASURY, LANSING, MICH. 48922

on or betore April 30, ; ; |

(or four months atter end of authorized fiscal year)

IMPORTANT—Be Sure to Answer the following Question When Applicable.
SALES

: - ao .

1. Business or Profession of Taxpayer. Phone No.3 63-0499

. Give year of lost return filed. IG 2H - Address of Last Return lathd! Sa ene
Check here if return is computed on a Retroactive Date Method._- lor Monthly Average Metheod—____

owe. ON

. If taxpayer is a corporation give State and Date of Incorporation.

Federal Employers Identification Number

. If this is the return of a Trustee attach list of némes and addresses of beneficiaries and date of creation of trust.”

» Hf this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached.

U declare under the penalties Inport by Act Na, JOl Pp, AL of 1999, ae Amanced, that this retu\en, Including any accompanying a

andl to the beat of my knowledge and belief Ina tue, correct and complete return,

Return Prepared by.

NW 88326 Docid:32245535 PYyS21WEST re

heen examined by |

Sociol Gecurity Number —

GORDON L. HOLLANDER, P.-C, - “em
ACCOUNTANT Signed
N MILE ROAD mae


i Ue INCOME ANU Caduree

OO O——

oUt bucd & — SHARENOCDERS SHARE
is

(ii aaditionai space i

needed, attach schedule)

(1) {2} (3) (4)
Name and Address of Each Shareholder Social Security Number of Amount taxable as ordinary .
Number Shares income (schedule K, total of i
lines 4 and 8, US. 1720S) }
ee i
(Biker my
esas) eso CHICAGO
+
{5) (6) (7) (8)
Distributive Income from Amount to be used by share- Enter here and on form Enter here and on form
paga 1, line 5, or page 2, holder on Mi-1040 (enter on Ml1-1040, page 1, line 22 MI-1040, each shareholder’s
schedule B, line 6 . page 2, schedule 1, line 34 or each shareholder’s pro- proportionate share of Single
on page 2, schedule 2, line 43) portionate share of per- business tax paid.
-difference between column 4 sonal property taxes (See instructions)
and column 5 paid on inventories or
{See instructions) the credit for franchise
fees paid.
. : (See instructions)
(a) ube, Syed
The
b) YG &Yo-.07
(c)
SESS SS nn tt
(d).
(e)
(f)
(g) ,
(h) .
(i) oo a ,
a RR
(j)- ;
NW 88326 Docld:32245535 Page 216 phar PS
a Sadie

:  HSCA (RG 233)

JFK Collection

Reference copy,

NW 60326

. ware : -
ww ws add ae ee

RRICHIGAN INDIVIDUAL INCOME TAX RETURN

_ 1975, ending —_______ —_-—_, 19

for 1975, or taxable year beginning

Y “First name and inilial (if joint reiurn, use first names and initials of both) Last name ~ {Your social security number_

Earl R. and Marge Ruby te

Home address (number and street or rural route) . Your occupation ~

w 18135 Livernois Sales
= City, town or post office. and State . ZIP code Spouse's social security no.
5 Detroit, Michigan 48221
= Residency Status during tax year: . Spouse's occupation
7 Resident [J Non-resident CJ Part-year resident, from —_______ to
“
S O filing Status: 1. Exemptions:
~ A CJSingle (a) Enter here the number of exemptions claimed on your

B Cl Married, filing jointly federal income tax return... eee gaa 4 4

: ays . . . - . wo e

¢ CMartied, filing separately (see instructions, page 2) (b) Special exemption for paraplegics & quadriplegics . [nstrsctiona]

a Name of Spouse ——— ——_______________- (c) TOTAL EXEMPTIONS, add lines Ia) and M(b).......-..----- @__ 4.
(Give spouse's Sac. Sec. No. in the space provided)
ish t i ; i NOTE: if you check the ‘YES’ boxes
2. STATE Do you wish to designate $2.00 of your taxes for this fund? 2) CEs KINO aoe t increase your tax OF
CAMPAIGN FUND If joint return, does your spouse wish to designate $2.007....- O YES KINO reduce your retund.

3. Adjusted gross income as defined in the Internal Revenue Code and which should be reported on Federal Form 1040,

. : Attach copies of any Federal schedules that indicate 3 loss or deduction

line 15, or 1040 A, line 12 trom gross income. (See page 5 of the instructions) ©... 6 ce ee array
4. Additions to adjusted gross income, (from page 2, line 35)..... 0.6.0.2. eee eee teeter enn
5. Total, add lines 3.and 4............... bbb bbb bbb debby edb e beet eee een neers
6. Subtractions from adjusted gross income, (from page 2, line 44)........2 ‘cud ence ene sees eee e eens enn e nee
7, Subtract line 6 from line 5... eens eee eect e tenn teen eens
8
9
0

_ Residents multiply exemptions claimed on line 1 by $1,500.00 (part-year and nonresident allowance from line 48) ....

> Attach State Copy of Form W-2 Here <

_{ncome subject to tax (subtract line 8 from line 7)... . 2.02.22 ee erence eee teense eters
10. Tax: multiply line 9 by 4.37% (.0437) 00ers
CREDITS (See instructions - pages 7-10) AMOUNT PAID - CREDIT

LL. Income tax paid to Michigan cities....... eve eter c esas @ 00/4 hia. a

12. Contributions to Michigan colleges & universities (attach receipts) . @ 12a.

13. Income tax paid to another state (attach copy of return)... ..... 13. ®.

14. Total credits (add lines lla, 12a, and 13a), enter total here... 1.6... cee eee eee teen ene 14, 20/04

15. Income tax, subtract line 14 from line 10 (if line 14 is greater than line 10, enter NONE’)... 0... ..- 20ers 15] 241784

16. Credits from any MI-1040 CR form. (see page 9 of instructions) ........------+20-0 (16) _ ;

Do not complete lines 17 thru 21 if you have claimed a credit on line 16.

17. Household income from line 56.0.0... eee eee es @

18. Enter 1975 homestead property tax or amount from line 59 ..... @
wy 19. Tax not eligible for credit, enter 3.5% (.035) of line 17......... 19.
» 20. Subtract line 19 from line 18, if line 19 is greater, enter ‘NONE’... 20. . pe
5 21, Property tax credit, 60% (.60) of line 20, ($500.00 maximum) ....... 0.000 seers 21. —-
5 22. Personal property tax paid on inventory. @ LK 39% 6.39). 22.
S ; PAYMENTS
23. Michigan tax withheld (attach State copy of W-2).......- 0.0.0 s sees eter ee eee @ AIS yO
= 24. Michigan estimated tax payments .......... vce eeceeeueneceeeteetnneees @ _ Toe} 2
S 25. 1974 overpayment credited to 1975......... Sev g cue teceuleetenenesneeaeees (75)
E26. Add lines 16, 22, 23, 24, and 25,/or lines 21, 22, 23, 24, and 25........--++. bebe tee tet terete, 26. G, ISSO
S 27. If line 26 is less than line 15, enter BALANCE OF TAX DUE HERE.........0..000-0ccceeeeeeevees PAL @ 340 [3
'S 28. if line 26 is greater than line 15, enter AMOUNT OVERPAID. 0.0000. 0cceeeeeee 28.
% 29 Amount of line 28 to be REFUNDED TO YOU... «2.2.2... 0c cece eee etree pe eset tent nes REFUND » @ al
A 30. Amount of line 28 to be credited to 1976 estimated tax......... 30) ee nod dine See gniryon line 30,

OFFICE USE

This return is due April 15, 1976 or on the 15th day of the fourth month after the close of your tax year.
Under penaities of periury. | declare that | have examined this return, including accompanying schedules and
statements, and to the best of my knowledge and beliet it ia true, correct and complete. If prepared by a person
other than the taxpayer. his declaration is based on all information of which he has any knowledge.

sign D> sescsgmine vps bee B aan! “OLERNGER asi

Here Ponce a SAC NY ccccc cee cee ce eeeet eens
PReiiisssasssnpaiva ray. BOTH must sign even if only one had income) } 9675 WESLLTEN Mike 8089 ; A Lan aoa
- ae ar ny eet a naumont tn — Michiga 89 ‘8, Drawer ving,

weneee San Can & ffoil eaturn ani

JFK Collection: SCA (RG 233)

Reference copy,

=

D-1040(N®) CITY OF DETROIT INCOME TAX 197 5

PLEAS

TY OF - =

cniy Git _ INDIVIDUAL RETURN —NONRESIDENT 3

DE i an or other taxable year beginning... ccc. cee eee . 1975, ending vote tte teeters Voce og

First Name and Initial - last Name EXTENSION NUJABE:

~ —
Earl R. and Marge Ruby a an ae

: tgs Your Occupation “TF you are an EMPLO’ GO

E (if joint return of husband and wife, use first names and middle initials of both) Sales enter your Federal EMPLO bd

lentification No. here: ise

PRINT Home Address (Number: and Street or Rural Route) Spouse's Social Security Number

18135 Livernois ‘ ' =

ie]
TYPE

A.

B.

moved.) If none filed, give reason.

3

City, Town or Post Office State Postal Zip Code
Detroit, Michigan 48221

‘APP.

Enter the name and address used on your return for 1974 (If the same as above write “Same”. if different, indicate date

JFK Collection

Auditor

Regular : 65 or over Blind Enter ‘ ey
SCHEDULE A— EXEMPTIONS + 1. yourself «1... . +s an (0: Oo cremations 9
Oo SPOUSE . . 2... eee eee ral - Oo oO chec +.
w 2. Enter first names of each of your DEPENDENT CHILDREN who lived with you: : Enter Mo. be
. . . :
© Denise Joyce 4-
= NAME . Months lived in ry
“ Enter figure 1 in the last column to . Relationship your home during ee
= 3 right for each name listed 1975 vo
OTHER ms
5 DEPENDENTS _
o i
= 4. Total exemptions from lines 1, 2 and 3; enter here and on line 15. below. eee cnrrnrrmerraremrrmceim | Oy
a
£ INCOME (If joint return, include all income of both husband and wife) ©
3 5. Enter GROSS income from employers for wages, salaries, commissions, tips, etc. — indicate (W) for wife ”
al Total wages reported Detroit Income Tax — WAGES, ETC.’ EARNED
° Employer's Name Where employed (City and State): on DW-2 or W-2 Withheld IN DETROIT
'
= GOR... CREAN EES, FENG co PET LAL 2d Sone OO OMe ad, Sonnac xy Bao Re A te
Go vvessmnntinnnnnatnnnainnnnnenn sete tteiunnnaintnanennnstnne 14,590) 29 M121 > E,250'50
5 6. TOTALS eee ete tect cease nett ene n nes 6, S00;0° 3B qe
oS
= 7. Rental income (or loss) from tangible property in the City of Detroit — from page 2, Schedule B, line 4...........0. 2 eee ee
< 8. Other income (or loss) from partnerships, etc. — from page 2, Schedule F, line 4. bce eee eee sep
9. Gain.{or loss) from sale or exchange of tangible property in the City of Detroit — from page '3, Schedule E, line 10. : va] sasessessnusesneneneeeeresneoenepees “
10. Net profit (or loss) from business — from page 3, Schedule C, line 8 .............. ee eee eee nets Dy cccecesteeneseeree feccieereeee
Oat Income (or loss) -TRUSTS AND ESTATES ONLY— from page 4, Schedule ‘G, line 7 (see instructions for exemption to enter on line 15) —
12, Total (add lines 6 through 11 of last column)... 0.2. eee eee errr ca feraees ae, IEF 113 eevee
13. Less: Deductions from page 2, Schedule M, line 5 (if none, enter La aS
14, Total (line 12 less dine 13) 200. ee eee eee Lene eae cote ASA
15. less Amount for Exemptions: Enter number of exemptions from line 4 above ; a im 2°
16. TOTAL INCOME SUBJECT TO TAX 43 7544 113

1

Attach Check or Money Order Here

PAYMENTS AND CREDITS ; .
18 a. Tax withheld by employer — from line "6 above — ATTACH Forms DW-2 or W-2

19. TOTAL — Add Lines 18a, _b, and ¢c
TAX DUE OR REFUND

20. If your payments (line 19) are larger than your tax (line 17), enter amount of OVERPAYMENT
21, | Check box if you wish overpayment on line 20 to be: (A) [] Credited on 1976 Estimated Tox or (B) al Refunded.

7, CITY OF DETROIT TAX: Multiply line 16 by .005 (42%)

b. Payments and credits on 1975 Declaration of Estimated Detroit income Tax

c. Other Credits — explain in attached statement (See Instructions)

> 22. Wf your tax (line 17) is larger than your payments (line 19) enter amount of BALANCE DUE Poy in full with this return. © [$...0..ce eee | eee

Make check payable to: “TREASURER, CITY OF DETROIT.” A balance due of less than one dollar ($1.00) need not be paid.

I declare that | have examined this return (including accompanying schedules and statements) and to the bestiof my knowledge and belief it is true, correct and

SIGN complete. If prepared by a person other than taxpoyer, his declaration is based on all information of which he has any knowledge.
——e | SIGN HERE
HERE b
SIGN HERE .
: (Spouse's signature and date) (If joint return, BOTH HUSBAND AND WIFE MUST SIGN) CERTIFIED PUBLIC ACCOUNFANT |
NW 88326

Docld:3A7Af535: FagadlBepartment, Treasury Division, 104 City-Ca G7 BEST, TEM AIL Minsaan 48224 -

NW Si aGtbeld: 32245535..Page 219............--...--:

erper ted an ty/b -
2 > Exempliins (number of ailowable exemptions times $1,500.00) .
3. Subtract line 2 from line 1. (This is your estimated taxable income). .
4, Estimated tax (line 3 times .046 of 4.6%). 662.0. Dob d eve ee eves
5. LESS: Total estimated tax credit for Michigan City income taxes. personal property tax on inventories,
Michigan homestead property taxes and contributions to Michigan colleges and universities
6. Subtract line 5 from line 4. Enter here and on line | below.....

oS MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR inoiviouats- 1976
MICHIGAN M1 040-€S

For calendar year 1976 or fiscal year ending —_____________, 19... STATE OF MICHIGAN
Department of Treasury

Address (number and street)
City, State, and ZIP code

Your estimate of 1976 income tax... 0. ee
Estimated income tax withheld and to be withheld during entire year of 1976...
ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)
_ COMPUTATION OF INSTALLMENT. Check proper box below and. enter amount indicated.
if this declaration is {CJ April 15, 1976, enter 1/4 of line 3: (C] September 15, 1976, enter 1/2 of line ‘t an
due to be filed on: ‘on 15, 1976; enter 1/3 of fine 3; (J Jan. 15, 1977, enter amount on line 3
. If you had an overpayment on your 1975 income tax return which you elected to have applied as a [
credit against your 1976 estimated tax, enter the amount here... 6... ee ee
6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To spread
credit evenly to each installment, divide it by number of installments and enter results here.......-.-.----- 00s sees
_ Amount to be paid with this declaration at time of filing (line 4 less line 6)... ee eee

Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit} with this return eliminates the filing of
quarterly estimates. Enter lump sum payment here..........

wf?
our
aay ;
watt

First name and initial (if. joint declaration, use names and initials of both}

Your social security number

Spouse's social securify number

& wre

wn

om

| have examined .this declaration and to the best of my knowledge it is correct. .
SiQnature(S) ...c.cceccecceesecesececeeceeceseeceeseseueeseerceeccnaseaeseseessenescccesesaeeenaeaeasseanensenanesnenees Daten. eee ce ce ceeeeeeeeneneeeee /19

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS— ] 976

For calendar year 1976 of fiscal year ending ____________, 19___ STATE OF MICHIGAN
Department of Treasury

am, FORM

tt

sat

yet
- yae

First name and initial (if joint declaration, use names and initials of both)
Earl R. and Marge
Please Address {number and street)
erye| 18135 Livernois
City, State, and ZIP code . :
Detroit, Michigan 48221
. Your estimate of 1976 income tax... eee
Estimated income tax withheld and to be withheld during entire year of 1976.00.00... tee
ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is fequired). ..
_ COMPUTATION OF INSTALLMENT, Check proper box below and enter amount indicated. - ©
If this declaration is hon 15, 1976, enter 1/4 of line 3; (September 15, 1976, enter 1/2 of line3) :....- [a 490,90
due to be filed on: { June 15, 1976, enter 1/3 of line 3; (Jan. 15, 1977, enter amount on line 3 } ;
If you had an overpayment on your 1975 income tax return which you elected to have applied as a
credit against your 1976 estimated tax, enter the amount here... 6.2...
6. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To
spread credit evenly to each instaliment, divide it by number of installments and enter results here.
. Amount to be paid with this declaration at time of filing (line 4 fess tine a
_ Note: The payment of the estimated tax (line 3 less any 1975 overpayment credit) with this return eliminates the filing
of quarterly estimates. Enter lump sum payment here :

mh WR

on

on

oe
| have examined this deciaration and to the best of my knowledge it is correct.

and

: HSCA (RG 233)

JFK Collecticn

Reference copy,

~ tar PAE 4k
ceeures s earintinnyn i :
se aang THIS NUMBER WHEN SUBMITTING PAYMENT, OR IN CORRESPONE — El

* Revenue Division
INTANGIBLES: TAX RETURN

faa]

Calendar Year 19. nN

OR FISCAL YEAR —____ . . co °
Beginning. 19 L.-----~+--~---------------- OO NOT WRITE ABOVE THIS LINE: --—————--—-~---~~- -- ee

Ending. 19 rt

a

isa}

d : RUBY EARL & MARGIE 698 85 5
eso | : 18135 LIVERNOILS AVE : . +
artnership. r Check DETROTLTT MI GA221

One rn _

Michigan Corporation

Foreign Corporation

POSTED FILED

Y IF THIS RETURN {§ FO!
ESTATE GIVE PROBA

Fiduciary

MONTH DAY “YEAR
11 30 75 : 698R55

RETROACTIVE DATE , ACCOUNT NO.

County____

1 2 File No..

FILE DATE Date of Death

COUNTY city eT

“e Computation of Tax Due © in TA 5

JFK Collection

1, Accounts and Notes Receivable (non-income producing only).

. Less Accounts and Notes Payable.
. Balance Taxable @ 1/10th of 1%.

. Accounts and Notes Receivable (income producing only).

. Less Accounts and Notes Payable (use only that portion, if any, not used in Line 2

Pal
Reference copy,

. Income applicable to balance.

. Tax @ 32% of Income (Line 7) or 1/10 of 1% of Balance (Line’6), whichever is greater.

. Stocks and Bonds ----- Schedule A, Column 9.

4
iy
A
ve
Nt

2.

3

4

5

6. Balance Taxable
; :

8.

9

0

10. Mortgages and Land Contracts ----- Schedule B, Column 8.
11, Annuities +--+ Schedule C, Column 9.
12. Beneficiary Return (attach copy hereto}
13. . TOTAL .|
4, [3S ous

14, Less Statutory deduction ($175.00 or $350.00 by husbands and wives filing joint return) _
15, . BALANCE DUE

16. Cash on Hand or in Transit as of retroactive date {include cash im safety deposit boxes)

17, Bank Deposits in Banks Located Outside of Michigan _ er Withdrawn from Mich.
Banks or Ass’ns. after

RETROACTIVE DATE.

15 22 0alG”
18. Savings in Building and Loan Ass‘ns. Located Outside of Michigan
19, TOTAL

a SS
20, TAX @ 40¢ per $1000.00 of Line 19.

21. . TOTAL TAX DUE (Line 15 plus tine 20) it a7

22. Less Advance Payment of Tax

23. TOTAL TAX DUE : 24. 2\be als
24, Penalties & Interest; Penalty — _ __%, $______;_ Interest. %___.__Months, $. 24} || —
25. TOTAL AMOUNT DUE : 25. Ale o2|&5
MAKE REMITTANCE PAYABLE TO STATE OF MICHIGAN ; : ;
Please forward Remittance for Amount Shown Here on or betore April 30.
To: MICHIGAN DEPARTMENT OF TREASURY, LANSING, MICH. 48922 (or four months after ond of authorized fiscal year)

IMPORTANT=Be Sure to Answer the following Question When Applicable.
1. Business or Profession of Taxpayer. SA Le . phone Ne G3- OOD

. Give year of last return filed. ogy SAE of Last Return. al t =

. Check here if return is computed on a Retroactive Date Method__-_____________Hm_or Monthly Average Method
. If taxpayer is a corporation give State ‘and Date “of Incorporetion———____________ Federal Employers Identification Number.

. If this is the return of a Trustee attach list af names and addresses of beneficiaries and date of creation of trust.”

Own ww

. If this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached,

te declare uncer the panaltios Imposed by Act No. A201 P, A, of 1999, as Amended, that thie return, Including any accompanying ached

hoen examined by +

and ta the heat of my knowledye and bealief ie a true, corert auc complete return. Social becurity Number ——
Return Prepared by, GORDON L. HOLLANDER, P.C. i: “ened
; 19675 ACCOUNTANT Signed
NW 88326-Bocid:322455 35g Raga,4 ST TEN MILE ROAD Tite

p] i a0nge Clee et te eee te a It


—gGteuce & — SHAR EZAGLOEAS SHAAE UF INCGWE ANG Cacia

(if additional space is needed, atiach schedule):

. : { {3)
Name and Address of Each Shareholder Social Security Number of
: : Number Shares

S

(4)
Amount taxable as ordinary
income (schedule K, total of
tines 4 and 8, U.S. 1720-S)

42 etoot

om
Co, Sto .oT

US tan IPSUM SS ESO CHICAGO FLL. below
(C) oc ee eee Le eee
id)... ces, cove ven eaebeentateeeees
-) sen eee Lee eee

(5) ; (6) (7) (8)

Distributive Income from Amount to be used by share-
page 1, line 5, or page 2, holder on MI-1040 (enter on
schedule B, line 6 page 2, schedule 1, line 34 or

on page 2, schedule 2, iine 43)
difference between column 4
and column &

(See instructions)

Enter here and on form
M1-1040, page 1, line 22
each shareholder's pro-
portionate share of per-
sonal property taxes
paid on inventories or
the credit for franchise
fees paid.

Enter here and on form
MI-1040, each’ shareholder's
proportionate share of Single
business tax paid.
(See instructions)

(a) UL, Gyo

: .

ib) YL &Ynor |.

(c)

(h)

NW 88326 Docld:32245535 Page 221

[iene Cl .

HSCA (RG 233)

JFK Collection

Reference copy,

SCHEDULE F — SHAREHOLDERS SHARE UF INCOME AND CHE) 13

4

(2) (3) a)

Name and Address of Each Shareholder -

(5)
_ Distributive Income fram
‘page 1, line 5, or page 2,
schedule B, line 6

{lf additional space is needed, attach schedule)

(6)

Amount to be used by share- ©

holder on Mi-1040 (enter on
page 2, schedule 1, line 34 or
on page 2, schedule 2, line 43)
difference between column 4
and column 5

(See instructions)

Social Security
Number

Number of
Shares

(7)

Enter here and on form
MI-1040, page 1, line 22
each shareholder's pro-
portionate share of per-
sonal property taxes
paid on inventories or
the credit for franchise
fees paid.

(See fastructions)

Amount taxable as ordinary
income (schedule K, total of
lines 4 and 8, U.S. 1120-S)

14 7 20.6

(8).

here and on’ form

each shareholder's

proportionate share of Single
business tax paid.
(See instructions)

SS TF TT

9730/6 4G.6/

fae EX ae

UtG.GT

OP BO

NW 88326 Dochd:32245535 Page 222

JFK Collection: H8SCA (RG 233)

Reference copy,


wien, Dept, of Treasur

a

WD mat Na es a a tn

BeOooS | sais We OF Partners or Shar 1976 c
| Parts shia, Subshaater $ Corp., Profe essional Corp.
: See instructions on reverse side
1 Name: 2 Account Number:
Cobo-Rumar Sales, Inc, 38-1812707
t

pier | SULIMARY

t
I
i

“3” Total Number of Partners or Shareholders... 00... ooo e ccc cevececeeecc vets ceceeeeeceeeecces <
4 Total Number of Qualified Partners or Shareholders from Part li—enter here and on C-8000, line 60a... as .

Ayan | QUALIFIED PARTNERS OR SHAREHOLDERS

“PARTNER S or SHAREROLDER $

‘A NAME AND ADDRESS B SOCIAL C % | DSHAREHOLDER’S | E
SECURITY NO. Time} SALARY vn F Share of Bus. Inc. | G Share of SBT Paid

| ‘Earl Ruby.

580 Stoney River; Birm.

% : 00 al tol

00

Sa 0}; 4 00} | 00

oo sf

ee ed : :

T H
| PAR G at NGN-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is neoded submit separate schedule and enter totals on line 7.

is

| never

[als % | 00 | 00

| 00

TOTALS
NW-88326-Boltd 3224

hand Part Ill
es page 2 )

JFK Collection: BSCA (RG 233)

Reference copy,

ltenl, wept. oF ireasury we Ne ee eee ee see

nyt es aor —- ea" amalna fay a PD mi ration on “es NTA Byars. nh ~ n
my - GOSS Oi Caras oi Selend aers— iwi6 oC
tue at | Day! ne Crataal . an > bud
Yr na wu mt retin aa x: a" ¢ f
Parimersiaip, SUscuasiey ) Gore, r7e: fog sval Corp.
See instructions on reverse side
11 Name: ; . 2 Account Number:

Cobo Cleaners, Inc. | : 38-1806433
layin» | SURIRIARY .
i 3 Total Number of Partners or Shareholders...... EE
4 Total Number of Qualified Partners or Shareholders from Part It—enter here and on C-8000, line 60a....[ 4 |

pad ul QUALITIED PARTNERS OR SHAREHOLDERS

te

A NAME AND ADDRESS B SOCIAL C % | DSHAREHOLDER’S |E % PARTNER’S or SHAREHOLDER’S
SECURITY NO. Time| SALARY Own. | F Share of Bus. Inc. | G Share of SBT Paid
> | ————=—= —————— ——— a
ae Earl Ruby
80 Stoney River; Bim. 10% 144,600 | 90 | Loe |. | 00 00
: % | 00 % | 00 00
; %, | 00 % | 00 004
% 100} 4% | 00 00
% 00 % 00 004

reorer i! TOTALS (Part I and Part Ili)
_ NW+88326-Bocld: 32245535 Page 224

mer dag’

JFK Collection: HSCA (KG 233)

Reference copy,

NW-88326

wica, Jest. of Treasury

Cobo Cleaners
hutine - | SUMMARY

”
ror)

2D o ee

a Ga

We i ene ee ee

ers OF

vie

We ween

Subchaater S Carp. Pro

See instructions on reverse side

‘Inc.

Sherer

lnmict
owiu

fessi

slag

ow

onal Corp.

2 Account Number:

E%

Own,

10@
%
_%
%

%

%

%

38-180

7
hei

i976

6433

PARTNER’S or SHAREHOLDER’S

3 Total Number of Partners or Shareholders:.... 0.00. ccc c ccc cc cece ce eee cette eer e eens ene nes
4 Total Number of Qualified Partners or Shareholders from Part |!—enter here and on C-8000, line 60a... 4 |
Lugit? 7 QUALIFIED PARTNERS OR SHAREHOLDERS
) NAME AND ADDRESS B SOCIAL © % |DSHAREHOLDER’'S
SECURITY NO. Time} SALARY
: | Earl Ruby , a
380 Stoney River; Birm.| SORBBMEY| 100) 144,600 | 00
’ % 00
% 00.
_ % | 00
% 00
g 00
% 00

d submit separate

F Share of Bus. Inc. | G Share of SBT Paid
| 00 | 00
| 00 | 00
| 00 | 004
| 00 1 00
| 00 00
| 00 100"
{00 [ 00
| 00 | 00}
| 00 | 00}
00 00

| -
ridsny Wi] NON-QUALIFIED PARTNERS OR SHAREHOLDERS. If more space is neede schedule and enter totals on line 7.

: .

Viger

hy TOTALS

Part Ul and Part |
Bocid:327245535 Page 225 )

00

00

00

%

I

00
00

%
%

| 00

| 00
| 00

| 00

| 00

maem gd Ac 4

JFK Collection: #8SCA (RG 233)

Reference copy,

Cobo Cleaners
| SULIRIARY

iaAyghe

3. Total Number of Partners or Shareholders
1 4 Total Number of Qualified Partners or Shareholders from Part tl—enter here and on C- 3000, line 60a.

a QUALIFIED PARTNERS OR SHAREHOLDERS

|
: A

Jan
ve
rere

See vie

ne OF ;
Saip, + Subohester & § > tora. Professional Corp.

Deve’
Partie

vente ae nee

@ Bae: ram
Caneel

S or

See instructions on reverse side

Inc.

2 Account Number:
381806433 ;
Ep

1976

_
I

r NAME AND ADDRESS | B SOCIAL © % |DSHAREHOLDER’S [E % PARTNER'S or SHAREHOLDER’S
SECURITY NO. Time} SALARY Own. | F Share of Bus. Inc. | G Share of SBT Paid
=} +
_ Earl Ruby
380 Stoney River: fr 10% | 144,600 | 00 106 00 00:
f 0, «| sto 00
% 00 % 00 00 |.
I 00 % 00 00 .
| 4 00 oo}
fh 00 00-
oO} ai. 00 - 00
| .
% 00 % 00 00
.
% 00 % _ | 00 00
% 0} 2 00 00
} "
aN Abel: NON-QUALIFIED PARTNERS OR SHAREHOLDERS, If more space is needed submit separate schedule and enter totals on line 7.
i
00
00
00
00
00
00 % . | 00 00
0 4% | 00 00
_ = 0) 4 1.00 00
NW B8dd6-pould ad4484% 'bany Pag!) 7 CO A)

JFK Collection: SCA (RG 233)

Reference copy,

videwene Meese ce tt wee wee semitone Sete cod Waleed we,

Sosa . . Depariment of Treasucy

1973, or iaxabie year beginning ©... . ....., G73, ending 2, (AGL,

“ JIA, uSe irs aames and imibals of Ooth) j +asi name

c2 =~ 1

= FA, RGE i SV oURY
+ 7

ZiP code | Sacuse’s sociai security no.

fot : | 1

aie on / cy iS pad : ; Ce ep | i
1. Exemptions-Enter here iotal number of exemptions claimed on your
1973 Federal income tax return

you a Michigan resicent orior to July i, 1972? B€¥es fINo

CiResident (fuli year)

status - Check One. Mi Married Filiag Jointly ; C1 Single

LU Married Filing Separately - Name of Spouse... .... (tee ee CiPari-year from 00.0.0 00. 10 eee
Give snouse’s social security mG. in space provided : 7 CNonresicent

VY 3. Adjusied gross income as detined in the Internal Revenue Code and which should be repofted on Federal Form 1040, apa

2 Attach copies of any Federal schedules that indicate a toss or deduction

— Line 15 or 1040A, Line 12 trom gross income. (See page 5 of the instructions)... 0 eee eee

os 4. Adaitions (irom page 2, line 36)... . bees Me een ences

eC re

(5. 6. Subtractions (irom page 2, line 44)... Tce cece ceees vec beter te eeeteevetvens

ss 7. Balance tineG Jess line 6). . ee een nner ecb bbb bbb bbe ney

e 5. Residents multiply exemptions s claimed on line 1 by $1200.00..0 22 ccc cece ea ee

2 Part-year and agnresident allowance irom line 48............... 0... eee eee ee ete vette eves

= 9. Income subject to tax (line 7 less fine 8). 00. e ee lee e cee cece eee ee

~3 (iO. fax: multiply jine 9 by .039 (3.9%) 0. vee ;

= CREDITS — ; AMOUNT PAID CREDIT

a ; (See pages-8, 9, and 10 of the instructions) ;
LL. income ‘ax paid io Michigan cits... 0.2.02. e Lie 7 ta, 2A? eet ,
12. Contributions io Michigan colleges and universities (aitach receipts) . i2a. ;
13. income tax paic to another staie (atiach copy of return).......... “3. o—j—2 a—___| ,
14. Total credits (add lines 114, 12a, and 13a,) enter total here... eee 14, a7
15. Subtract line 14 from line 10 (If line 14 is greater than line 10, enter NONE)... 000.0000 cee ce ccc cee ceva eevee 15. ee ew
HomesieaG pioperiy tax relief - ines 16 thru 20 - senior citizens, veterans and blina persons see form MI-L040CR. .

y 16. Enier 1973 homesiead property tax or line 51.00... @

_ 2 7. sousenold lacome irom fine 58°......... G@ —___ 1

= 18. Enier 3.5% (.035) of Household income shown on fine 17......... 18.

S 19. Diiference between line 16 and line 18 (If line 18 is greater

2 than line 16, enter NONE). cece eee e ee 19. —__

§ 20. Enter 60% of line 19 (Maximum $500.00) 0.00000. c cee cece eee a

= 21. Credit from MI-LO4QCR (attach form MI- 1040CR).. cobb eben bette vce tte ec eees Ot

= 22. Parsonal property tax paid on inventory........0.......00000. (22) |

2 23. taveniory iax credit ~ 25% of ling 22........... Lobe chee even nea es Deke eee. 23. —

= PAYMENTS ; _o;

= 24, Michigan tax withheld (attach State copy of W-2)....... 00. bce ec eee @ RALl o-

a 25. Michigan estimated tax paymemts. ee S. GFT) 00
26. | :
27. ¢
28. if a :
29. lf line 27 is greaier thaa line 5, enter OVERPAYMENT HERE. bocce cease vee, erent teens 29. ee
30. Amount of tine 29 you wish to apply to your estimated tax payments......................., eve cece aes a J
31. Amouni to be REFUNDED (subiract line 30 from line 29)... e cece cece eevee cece cee eee eee, ee

This return is cue April 15, 1974 or on the 15th day of the fourth month after the close of your tax year.

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it
is true, correct and complete. lf prepared by a person other than taxpayer, his declaration 1s based on all information of which he has any knowledge.

ca . .
. ‘ ee eee ee i Pe eee ee ee
Sign wa Your signature : : Date > Signature of preparer, other than taxpayer Date

>. Spouse's ‘signature it filing ‘jointly. BOTH must sign even if only ‘one had. income) GORDON Lo HOLLANDER, P. Cc
Make checks payable to “State of Michigan.” Mail return and payment to — MichgERtisize: Pagdd. eopuitrinrany Michigan 48904

17350 TEN MILE ROAD Py
NW 88326 Dochd:32245535 Page 227 , SOUTHFIELD, MICHIGAN 4207¢,

Here ~


miptions times $4,560.00) eee eee

'

vet. (This is y yOur esiimaied isxable income).......0.......... ov ebeeeeseuu eeu bvitesineseeens
& Estimated tax Gine 3 times .039 of 5.9%). 000 ee Dee ee eect eee
5. LESS: Totai estimated tax credit for Micnigan City income taxes, persona: property tax on inveniories,

whcnigaa homesiea 6 propery taxes anc contribuiions io Michigan colleges and universities... .. eae

6. Subiraci line 5 from fine 4. Enter here and on fine i below... cece cece cece eves veeees

Department of Treasury

MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR InDIVIDUALS_ 2 O74 |.
|

|
=
: on oT For calendar year 1974 or jiscal year ending 19... STATE OF MICHIGAN

i First name and initial (if joint declaration, use names and initials of doth) | Last name . Your social security numoer

| i sO i

| |
Please | Address (aumoer and street} . Spouse's social security numoer
‘ - i y

print J . .
or type | : ; : i
City, State, and ZiP code

. Your estimate of 1974 income tax-....¢..... Sees. ence teense Looe e eee occas
stimated income tax withneld and to be withiiele during entire year of 1974.0... eee,
STIMATED TAX (line 1 fess.iine 2). (If less than $100, no ceclaration is required)............. Meee ee
. COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated.

if tis declaration is STapri 15, 1974, enter 1/4 of line 3; (] September 16, 1974, enter 1/2 of line a
due to be filed on: 4] June 17, 1974, enter 1/3 of line 3; (J Jan. 15, 1975, enter amount on tine 3

Roe

r
cs

_

5. if you had an overpayment on your 1973 income tax return which you elected to have applied as a [| ,
credit against your 1974 estimated iax, enter the amount here..... 22. eee : =
9. To apply entire overpayment credit to this installment and any excess to the next, enter here the amount on line 5. To spread
credit evenly to each installment, divide it by number of instaliments and enter results here............. pees | auceeaeeseeeeeeeeesnseceeeseeeeees ‘
7. Amount to be paid with this declaration at time of filing (ine 4less line 6)... ee eee eee ee ae
3. Note: The payment of the estimated tax (lite 3 tess any 1973 overpayment credit) with this return eliminates the iiling of

quarierly estimates. Enter lump sum payment here... cece

i have examined this dectaration and to the best of my knowledge it is correct. :
Signature(s)....eecseceecsecsseseeeere se seseescneceesesssessecoesececossaeseetaqessseseseaaeeguceaessaseseenacsaeesees Date. ee eeeeeeeeceeceesneceeeneeseens 19

| MICHIGAN DECLARATION OF ESTIMATED INCOME TAX FOR INDIVIDUALS 2 {7/4} vont
: Uni

Ml-1040-ES

For calendar year 1974 or fiscal year ending -________ 19s STATE OF MICHIGAN
, . . Department of Treasury

First name and initial (if joint declaration, use names and initials of both) Last name Your social security number

PL AND STARGE am sg:

Piease : Address (number and street) . Spause’s social security number
ariat

or type (BIBS LIVERLA OIE - : . ;

| City, State, and ZIP code. . .
DST ROT AI CH IGAN Y&Da)
. Your estimate of 1974 income tax. ete
. Estimated income tax withheld and to be withheld during entire year of 1974...............
. ESTIMATED TAX (line 1 less line 2). (If less than $100, no declaration is required)
COMPUTATION OF INSTALLMENT. Check proper box below and enter amount indicated. . :
lf this declaration is {®April 15, 1974, enter 1/4 of line 3; (]September 16, 1974, enter 1/2 ofline3) $93.80 7
due io de. filed on: {eae 17, 1974, enter 1/3 of line 3; (Jan. 15, 1975, enter amount on line 3 \
. If you fad-an overpayment on your 1973 income tax return which you elected to have applied as a
credit against your 1974 estimated tax, enter the amount here.................... 00.0000.
6. To apply entire overpayment credit to this instaliment and any excess to the next, enter here the amount on line 5. To.
spread crecit evenly to each instaliment, divide it by number of installments and enter results here
. Amount to be aaid with this declaration at time of filing (line 4 less line 6)
. Note: The payment of the estimated tax (line 3 less any 1973 overpayment credit) with this return eliminates the filing ”
of quarterly estimates. Enter lump sum payment here... 1 eee

me OF mw

an

cn

1 have examined this declaration and to the best of my knowledge it is correct.
SiQMAUUE(S) Lae. e cece eee ee cecsegeeceaeseeceaessecceeesecaceceneceecseaeescsaeesaseeeseneeeees sersesteceecesesecceeee Date

NW 88726 Dochd:3224553 Page RR husband and wife must sign

er otner re

1
PoNeone une indiul Lost 7 : Your Sosias Secuiy Numoer |
: be f
‘ \ :
: aan : :
G FTG42GS3 Your Occupation
qi rorer .
Be Aciiress (Na i are i = x Z
. RUEY EARL §€ MARGE | Spouse's Secial Security Nurser
ee tote cain7e ; 1 H
> LSi35 LIVERNOIS I i !
resi : \ Spouse’s Occupaiion
cre , © 7
QETRRIT, ME 48221 P ; OF OR
; Hi
CO ee Bo caeeeasoeesennd iene ae
2
t
. 5
A. if married, is spouse filing a separate return? (J YES Le] NO. If yes, enter spouse's first name... ee i
/
L
8. mo and. address use ‘Same, Wi different, indicate date j
If none filed, give reason. * budisas
R Audie

Regular 65 or cver
ee

WEDULE A—EMEMPYTIONS (1. voursele . 1...
SPOUSE. 2... ee

3. Tote! exemptions from tines 1, 2 and 3; enter here and en line 15 bel OW, — eer vo

2 ee eE

5
, | NAME To Monins lived in | |

pi Enter figure 1 in the last column to { _ Relationship your home duri H
3. ! . tight for each name listed 1973 {. i
| oe
( { icp
i | —
re i |

£

a ae a nh Sa
INCOME (lf joint return, include ail income of beth husband and wife)

5. Enio cr GROSS income from employers for wages, salaries, commissions, tins, etc. — indicate (W) for wife 1
. Total wages reported Detroit Income Tax
Empioyer’s Name Where employed {City and ae) on DW-2 or W-2 Withheld
-~ ona ~ °
ae - as .

6 ALS

7. Rental income (or joss) from tangible property in the City of Detroit — from page 2, Schedule 8 line 4..00..0.00. 00. !

Cther income (or toss) from partnersnips, etc. — from page 2, Schedule F, line 4....... ee ee eee eee

co

%. Gain (or loss) from sale or exchange of tangible property in the City of Detroit —from page 3, Schedule E, line 10

1. Net profi (or ioss) from business — from page 3, Schedule C, line 8 ......... Lee eee ee eee eee

Less Amount for Exemptions: Enter number of exemptions from line 4 above ...............
id. TOTAL INCOME SUBJECT TO TAX .......
17. CITY OF DETROIT TAX: Multiply line 16 by .005 (4%)
PAYMENTS AND CR EDITS
‘13. a, Tax withheld -by employer — from line 6 above — ATTACH Forms DW-2 or W-2

b. Payments and credits on 1973 Declaration of Estimated Detroit income Tax.

c. Other Credits — explain in attached statement (See Instructions) ©0000... 0.0.00. c cv ee ceceeunae Dee eee
19, TOTAL — Add Lines 18a, b, and ¢ 0... ce eet be beeen ence.
, TAX DUE OR REFUND
< © 20, your payments {line 19) are larger than your tax (line 17), eater amount of OVERPAYMENT,
a
/

23, Check box if you wish overpayment on line 20 to be: (A) (7 Credited on 1974 Estimated Tax or (B) Tel Refunded. , |
oor 4 : we . . woz !
22. If your tax (iine 17) is larger than your payments {line 19) enter amount of BALANCE DUE “Pay j in full with this return. @ 8 dceeeeee

thane check payable to: "TREASURER, CITY OF DETROIT.” A balance due of less than-one dollar ($1.00) need not be paid.
eee ee DETRU TA balance due of less than ‘one dollar (51.00) need not bx

i deciare that | have examined this return (including accompaaying schedules and statements) and to the best of my knowledge and belief it is true, correct and
complete. If prepared by @ person other than taxpayer, his declaration is basad on all information of which he has any knowledge.

SIGN KERE

{Spouse’s signature and date) (If joint return, BOTH HUSBAND AND WIFE MUST SIGN)

eerie PUBLIC "eceoe

AMAIL TO; City Treasurer, 104 City-County Building, Detroiti 7ghi EN FGReS pops ee
RETURNS MUST GZ FILED BY APRIL 2030U7AFIELD, MICHIGAN “2c

NW 88326 Docld:32245535 Page 229

SER WD

2UaN

wages TAK F
Apo ~ < “37.
ee rere Ey mee

i
\
|

Me ae oe SE its i
i
i

Od S.SCAL YEAR

vee ae RUBY EARL & MARGIE 69 33 5 5
InCiviGve) i
serach i 18135 LIVERNGIS AVE

. oration | | check DETROIT MI 48221
Nocnigan Corporation | }

One H

Foreign Corporation H . . i FILED
Sida: ! - ——_H#_
Fiduciary . v Nis FOR AN

ESTATE GIVE PROBATE

{  MoaTa DAY | YEAR {
OAT A ' County.
ae “~ H Ss
fous i 2 72 1 98 855 File No.
RETROACTIVE DATE ACCOUNT NO. Date of Death
- Line ™ panel tan, fom TT.
ie WOTADUIHON Of LaxK Lue
1. Accounts and Notes Receivable (non-income producing only) to

2. Less Accounts and Notes Payable. a

Balance Taxable @ i/i0ih of 1% tt

oD

. Accounts and Notes Receivable (income producing only).

. less Accounts and Notes Payabie (use only that portion, if any, not used in-line nn a es ee
. H i

7. income applicable to balance

tok

on

8. Tax @ 342% of Income (Line 7) of 1/10 of 1% of Balance (Line), whichever is greater.__

9. Stocks and Bonds-.-++ Schedule A, Column 9,_~
16. Mortgages and Land Contracts----- Schedule B, Column 8.
11. Annyities s-.+ + Scheduie C, Column 9.

TD. Seneficiaey Return (attach capy hereto)

ren OD 0 neces tee tnecte ect ene ee
tae Loss Statutory deduction ($175.00 of $350.00 by husbands and wives filing joint rotuen) — __.

, _———

15. BALANCE DUE

i6. Cash on tisnd or in Transit as of retroactive date {include cash in safery deposit boxes)

{of Withdrawn from Mich.
Banks or Ass’ns. after

{ RETROACTIVE DATE.

i7, Bank Deposits in Banks Located Outside of Michigan.

18. Savings in Building and Loan Ass’ns. Located Outside of Michigan,

19. TOTAL

20. TAX @ 40% per $1060.00 of Line 19.

2. TOTAL TAX DUE (Line 15 plus Line 20)

22. : : Less Advance Payment of Tax

23. TOTAL TAX DUE -
26. Penalties &, Interest; Penalty %, $2; Interest_ % Months, $. Log

TOTAL AMOUNT DUE
RE REMITTANCE PAYABLE TO STATE OF MICHIGAN — ; . A

Please forward Remittance for Amount Shown Here on or before April 20. i
To: MICHIGAN DEPARTMENT OF TREASURY. LANSING, MICH. 42922 “(or four months ailer end of authorized fiscal yea:)

" TMPORTANT—Be Sure to Answer the following Question When Applicable.
SALES: - G4

Phone No.=. 3

i. Business or Profession of Taxpayer:

2. Give year of last return filed. — LAGI pdcress of Last Return. SAME E

3. Check here if return is computed on a Retroactive Date nr” ae Monthly Average Method

4, if taxpayer is a corporation give State and Date of Incorporation. Federal Employers Identification umber.
5. If this is the return of a Trustee attach list of names and addresses of beneficiaries and date of creation of trust,

6. if this is a Business Return a copy of the Balance Sheet as of the close of the Tax Year must be attached.

| declare under the penalties imposed by Act No, 301 P. A. of 1939, as Amended, that this return, including any = “examined by .
and to the best of my knowledge and belief is a true, correct and complete return. Social Security Number
- n 4 ‘ .
GGNCCN L HOLLANDER, P.C. Signed
Return Prepared b HED BHE-AGED! ANT —— : . of
" AEB-PU ONT: Signed
37350 TEN MILE ROAD .

Bedress UTHEIELO, -MIGHIGA t8075 Tne State whether Individval Own:
NW 60326 Dochd:32245535« Page 230n eevease sive “Administtator, Trustee, oid, OF


we ee

TAR CON.

Toof GH15-SIT-S hey, S673}
TTT
: i

IN ee ee

AL TOTAL DETROIT INCOME EXPECTED IN 1974 : S j
: H . i .
aa (369,00 FOR ACH EXEMPTION) $
C. SSTMMATED SEYROWT TAXABLE INCOME (LINE A LESS LINE 8) $
&. ESTUMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 1% OF 1% OF LINE Cc. : | 3 ;
|

ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE ib OF DECLARATION 8 OW

CITY Of DETROIT DECLARATION OF ESTIMATED INCOME TAX . ‘ 7? TS
For Culendar Year 1974 or Fiscal Year Ending , 19. 2 oe
(PRINT O88 TYPE; . 1 YCuR SOCIAL SECURITY NUMBER CHECK TYPZ OF DECLARATION

H
ne
DDD RES . ot ! i
ADRESS : a ee

SPOUSES SCCIAL SECURITY NUMSER

INDIVIDUAL
CORPORATION
PARTNERSH!?

ICICI

city STATE POSTAL Z2!P CODE saad
. : Cj CTHSR
. a
Nace le. Your 1973 Detroit tacome Tex Soca sunt 1b. Your Estimate of 1974 Detroit Income Tax... ..., | Sooners ; vevttesesenes
2. Amount of Detroit Income Tax to de withheld or other credit expected in 1974............0....., wee | ae
THUG 9. ESTIMATED TAX (line 1 fess Hine 2) eee e eee, ee
4. Computation of Installment: Check Due Date of declaration below and enter poriion of fine 3. as + indicated:

2504 Oo Apr. 30, 1974-1/4; [-] June 30, 1974—1/3; a Sept. 30, 1974~1/2; dan, 31, 1975—100%

5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit en ee a)
nan 6. AMOUNT TO &E PAID WITH THIS DECLARATION (line 4 less line 5)........................ eee. | 5 {
POR : ee
—e ef
YOUR

ECORDS. iF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
MAKE REMITTANCE PAYAELE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tex Return,
AND MAIL WITH DECLARATION TO: .

OFFICE OF THE CITY TREASURER — INCOME TAX DIVISION : DATE
104 CITY-COUNTY BUILDING
DETROIT, MICHIGAN 48226

V DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

O40-85 CITY CF DETROIT DECLARATION OF ESTIMATED INCOME TAX
For Calendar Year 1974 or Fiscal Year Ending...

CJ INDIVIDUAL
[EL CORPORATION
OD PARTNERSHIP
(7 OTHER

a. Your 1973 Detroit Income Tax $.. AS ‘0-53 1b. Your Estimate of 1974 Detroit Income Tax ...... .

2." Amount of Detroit Income Tax to be withheld or other credit expected in 1974.....0.0........... 000,
3. ESTIMATED TAX (line Yb less line 2) 2c b bebe nes 9
4. Computation of installment: Check Due Date of declaration below and ‘enter portion of line 3 as indicated:

2 Ape. 30, 1974-1/4; [7] June 30,1974~1/3; (1) Sept. 30, 1974-1/2; (J Jan. 31, 1975-100%
_5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit
AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER ee

DOCUMENT LOCATOR NUMBER

1 CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tox Return.
= eee
Sunatury oF Taxpayer. Spouse also if joint declaration. . CATE .

NW 88326 Docid:32245535 Page 231

3. Cost oF
oiver sasis

|
|

ot a eet

ciaimed in Schedule A .
mere and on fine 21, pape i

MMAGY Of BEPRECIATIC

Straigne ii

soe instructicas) .
instructions). .
5, whichever is lesser). Enter

NW 88326 Dochd:32245535 Page 232 ; Tow rm iammans


os aren vet ES, BS Bk oe ee _

Tanta! maite! Bae fey 2 yearn Rett
come rental sousing . S of mere Su

hit lane ben
FO RUE .coS Gs

IAP IIT,
at
pgerererassery

ng ingerporates

AG, Bade
shane owned,
year have eay
31?
Saye ar ‘ 34 ra .
é vank, securlliés, or other
mh coun?
“shoe Fors 5 Tailions, see

patties f
Facrtratan)

bata tay arinatants
GSO Ane Pca,

be

NW 88326 Docid:32245535 Page 233 rere ene


ee ene tee sere MEI Se ee ee tee Lee
, : BONER Wee ee Bee OL = : ~e -  e
. . . f
Coof Daly. Ted (Raw. 2-73) .
: a
AL TOTAL OSTROW INCOME ERECTED IN 1974 a 1S

ZACH EXEMPTION)

©

VED DETROIT TAXABLE INCOME (LINE A LESS LINE 3)

TAK-NONRESIDENT INDIVIDUALS ENTER OF 1% L
2% OF LINE C. ENTER TAX HERE AND ON LINE ib OF DEC

re wv 4 t
[- Youd sociar srcuany NUMER] SOCIAL SECURE NUMEIR UT chic TYPE OF DECLARATION

t i
SPOUSES SOCIAL SECURITY NUM2E

See

city STATE POSTAL ZIP CODE ' !
|

la. Your 1973 Detroit income Tax Si. 1b. Your Estimate of 1974 Detroit Income Tax ....... !

2. Amount of Detroit income Tax to be withheld or other credit expect ted in 1974.00.00... cet

SEIS 3S. ESTIMATED TAX (line 15 less line 2) . : Pee eee ee Se eee ee
4. Computation of Installment: Check Due Date of declaration below and enter gortion of line 3 as indicated:
COPY LI} Ape 30, 1972-1 /4; 0] tune 30, 1974-1/3; CE Sept. 30, 1974-3/2; LJ “dan. 31, 1975—100%

5. Less: Amount of overpayment on 1973 return which you elected to claim as a credit rn
6. AMOUNT TO SE PAID WITH THIS DECLARATION (line 4 less line Spee ee

tf YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

VITANCE PAYABLE TO “TREASURER, CITY OF DETROIT” - This declaration of estimated tax is not a Tax Return.

AND MAIL WITH DECLARATION TO:

OSFICE OF THE CITY TREASURER — INCOME TAX DIVISION : DATE
104 CITY-COUNTY BUILDING -
DETROIN, MICHIGAN 46225

RFORATION AND SEND FORM SELGW WITH YOUR

CITY OF DETROIT DECLARATION GF ESTIMATED INCOME TAX a
For Calendar Year 1974 or Fiscal Year Ending... Do,
RP CWECK TYPE OF DECLARATION
ig INDIVIDUAL
; CORPORATION
C) PARTNERSHIP
[OTHER

Lt VS AL AES

STATE
Mice IGA

POSTAL. Zi

-CODE

“1a. Your 1973 Detroit income Tax $...... AIPOS | ‘1b. Your Estimate of 1974 Detroit Income Tox Q. Lae
2. Amount of Detroit income Tax to be withheld or other credit expected in 1974....... ee L
3. ESTIMATED TAX (line Tb less line 2) 2.0.0.0... eee oe OES —
4. Computation of Installment: Check Due Date of declaration below and enter pottion “of fine 3 as indicated: [ i

TT apr. 30, 1974-1/4; [7] June 30, 1974~-1/3; (Sept. 30, 1974-1/2; [Jan 31, 1975-100% | Sel
5. Less: Amount of overpayment on 1973 return which you elected to claim as a CPE Re 1s

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)
i

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

DOCUMENT LOCATOR NUALBER

{ CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not G Tex Reiura.

Signature of Taxpayor. Spouse also if joint declaration. . OATE

NW 88326 Dochd:32245535 Page 234

}

Name and Addrass of Eaca Snaranoidar

i i
| i
i
1 :
i
1 i

total
U.S.

Income (schedule «x,
of lines 4 and 8,

1720-8)

tine 5, or page 2, schedula a,
line 6

NW 88326 Docld:32245535 Page 235

(6)

Amount to ba used Gy shareholdar on

Me SO OF Gi ee ek, Bee

line 43) Giffurence between columa

4 and column & (sae instructions)


we Nee ee

See oe

s A LESS LINE 8)

co)

PROIT INCOME TAX-NONRESIDENT INDIVICUALS ENTER % OF 3

Uwe

%& OF LINE C. I's
PAYERS ENTER 2% OF LINE C, ENTER TAX HERE AND ON LINE Tb OF DECLARATION BLOW

F DZIRCIT DECLARATION OF ESTIMATED INCOME TAX - °
y Your 1974 or Fiscal Year Ending 0 . 19... 2

| YOUR SOCIAL SECURITY NUMBE 7 Pe CHECK TYPE OF DECLARATION
oe

! ; iG INDIVIDUAL

Co
|_ spouses SCCIAL SECURITY Numsealid CORPORATION
T PARTNERSHIP

(J OTHER

city _ STATE POSTAL Zi? CODE

HEI la. Your 1973 Detroit lacome TEx Soo cecccccccsesse veut 1b. Your Estimate of 1974 Detroit Income Tax .......
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1974
3. ESTIMATED TAX (line 1 lass line 2) 0 cece eee ee ee
4, Computation of Installment: Check Due Date of declaration below and enier portion of line 3 as indicated: i
eouy CJ. Apr. 30, 1974-1/4; [1] June 30, 1974-173; Sept. 30, 1974—1/2; (1) Jan. 31, 1975--100% | Sossceretusnenneiennnee meer
5 ‘

oH

Ne Ne !
- Less: Amount of overpaymeat on 1973 return which you elected to claim as a credit —— $

aS - AMOUNT TO 5 PAID WITH THIS DECLARATION (line 4 less dine 5)... .000..0,.0... an ae 5 '

FOR : : ————

if YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
Sener

REMUTANCS PAYAELE TO VTREASURER, CITY OF DETROIT“ This declaration of estimated tex is not a Tox Return.
MAIL WITH DECLARATION 70: :

RECORDS

Ge “5 CITY TREASURER — INCOME TAX DIVISION _ DATE
104 oily. COUNTY BUILDING
DETROIT, MICHIGAN 48226

V DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

“TOLD-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX
~_ For Calendar Year 1974 or Fiscal Year Ending

(PRINT OR TY?€). ~
fe GAD

7 ER | CHECK TYPE OF DECLARATION
= :
|, ie INDIVIDUAL

1 ‘O PARTNERSHIP
i 1 OTHER

city ™ ee STATE
Sos mong MPO aa

“da. Your 1973 Detroit Income Tax s. 1 S80-53 1b. Your Estimate of 1974 Detroit Income Tax
2. Amount of Detroit incame Tax to be withheld or other credit expected in 1974......................
ESTIMATED TAX (line 1b less line 2) cece eee,
4. Computation of installment: Check Due Date of declaration below and ‘enter portion of tine 3 as indicated:

UE Apr. 30, 1974-1/4; [1] June 30,1974~1/3; [] Sept. 30, 1974—1/2; C] Jan. 31, 1975-100%

Less: Amount of overpayment on 1973 return which you elected to claim as a Credit
AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5). .

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER —

DOCUMENT LOCATOR NUMBER
w

L CERTIFY THAT THiS 1S A CORRECT DECLARATION. - This declaration of estimated tax is not a Tex Return.
ner
ayounsre of Tuapuyer, Spowse also if joint declaration, : CATE

Nw 88326 Docld:32245535 Page 236

iN 1974

MTS (9500.00 FOR EACH EXEMPTION)

. ‘
wed .

c. AVES OETAOIT TAKASLE INCOME (LINE A LESS LINE 3) $ ‘

o. & TAX—NONRESIGENT INDIVIDUALS ENTER 4 3 :

KR 2% OF LINE C, ENTER TAX HERE AND ON LINE

CX T¥Pl OF SECLARAT.

INDIVIDUAL
CORPORATION

ral
w

NAMES) \PRENT OR TYPE) -

POSTAL ZIP CODE}

a ib. Your Estimate of 1974 Detroit Income Tax

“A

mouar of Detroit income Tax to be withheld or other credit expected in 1974

ESTIMATED TAX (ine 12 less line 2) .

4. Compuraiion of Installment: Check Due Date of daciaration below and enter portion of | iine 3 as indicated:

coey Cl Ape. 30, i97s—ife; Li] June 30, 1974~1/3, GF sept. 30, 1974-7/2; TJ] den. 31, 197S—100%
3. Less: Amount of overpayment on 1973 return which you elected to claim as a credit —__;

AMOUNT TO &E PAID WiTH THIS DECLARATION (line 4 lass Hne 5)

iTTANCE PAYABLE TO “TREASURER, CITY OF DETROIT“ This declaration of estimated tax is act @ Tex Astura,
HL WITH DECLARATION TO; : . :

= OF THE CITY TREASURER — INCOME TAX DIVISION . DATE
4 CITY-COUNTY BUILDING
OSTAGIY, MICHIGAN 48228

3
% DETACH ON # REORATION AND SEND FORM BELOW WITH YouR & ce
DP S4G-35 CITY OF DETROIT DECLARATION OF ESTIMATED INCOM TAX
For Calendar Year 1974 or Fiscal Year Ending. , 19
SARE PRINT OR TYPE, = Se, [YOUR SOCIAL SECURITY NUMBER | Guack TVoE 0} SHCLALATION

INDIVIDUAL

CORPORA i
ARTNERSH IP
OTHER

as

Ww
“
5e)
Cc
S
nm
ny
°
oO
18
=
a
fad
8
<
Zz
Cc
é
2
é
Hole

a
Ox

CiTv~., . _ STATE POSTAL ZIP_CODE
MO Pay LQICH IGA Opes

RIG

{

la. Your 1973 Detroit Income Tax $. wt lb, Your Estimate of 1974 Detroit Income Tax
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1974
3. ESTIMATED TAX (line 1b less line 2) ......00.0.. To,
4.

“Compytation of Installment: Check Due Date of declaration below and enter portion ‘of fine 3 as indicated

Ld apr. 30, 1974-1/4; [7] -dune 30, 1974-1/3; (2 Sept. 30, 1974-1/2; [0 Jan. 31, 1975—106%
Less: Amount of overpayment on 1973 return which you elected to claim as a credi>
AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5).

CAT
fey

3 :

g iF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER —

© | CERTIFY THAT THIS 1S A CORRECT DECLARATION. ; This declaration of estimated tax is not a Tax Return.
Signature of Taxpayor. Spouse also if joint declaration. _ DATE

NW 88326 Docld:32245535 Page 237

SCnEOULE F — SKAREHOLOEAS SHARE OF LACUS AND CAdGiVS
(lf additional space is needed, attach schecuia)
a
i
a 2) (3)
Name and Address of Each Sharehoidcer Social Security Numer of
Numibgr Saares
{
ave Ha fel LS
LGW. WASHING Tat tle 7
[ed
1)
(f) ;
CG) ces ee cece ee eeee seen ee teen EERE EAGER; EA GA EEE; HH EE; EE ERE EE AGHE EEE AeE Oa EE EHO EE ES
(h) ow... eee eeeeee Leen EEE E EERE EEE EERE EEE ROE SEES REE E EEE EERE EES che taeeeeaes
1) iecesceeneeeeseeseeneenees seeeee beeeaeaes cheeeeeeeeas vee be eae ceeceeeeaeeesaerntnesatnees
(i) : . ‘
Se
CG) celcccececeseeceeeeeensnes eee ues eeteeeneneeaeaeneaes Veeeeee Lee ee nee enee tee eeeees ;
a Ce Ne
.

(4)

Amount taxable as ordinary
income (schedule K, total
of lines 4 and 8&8 U.S.
1120-S)

TTT

(5)
Distributive income from
page 1, line 5, or page 2,
schedule B, tine 6

(6)
Amount to be used by share-
holder on Ml-7040 (enter on
page 2, schedule 1, line 37 or
on page 2, schedule 2, line 46}
difference between column 4
and column 5 (sea instructions)

(7)

Enter here and on form
MiI-1040, pace 1, line 25
each snarehoicer’s aro-
portionate share of per-
sonal property  taxvs
paid on inventories or
the credit for franchise
fees paid.

{see instructions)

fa) S169. OG FG, 169-69 a

{b) G4. 69 9 165.64 Ge
(c)

(d)

(e)

(f)

(h) .
um i. - a

(i) , :

(i)

NW 88326 Docid:32245535 Page 238

Sa i » Mae ond

eds CY OF Det VECLARALON OF TAD UNO TAK
oo TAX COMPUTATION SCHEDULE
C of D-i5-DIT-J (Rev. 8-74}

A, TOTAL DETROIT INCOME EXPECTED IN 1975 : | S |
f

B. EXEMPTIONS (3600.00 FOR EACH EXEMPTION) | $ ;

C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 3)

D. ESTIMATED DETROIT INCOME TAX=NONRESIDENT INDIVIDUALS ENTER ¥2 OF 1% OF LINE C.
ALL OTHER TAXPAYERS ENTER 2% OF LINE C, ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW

D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX

NAME(S) (PRINT OR TYPE)

(INDIVIDUAL
(1 CORPORATION
( PARTNERSHIP
O OTHER

ADDRESS

POSTAL ZIP CODE

‘

KEEP la. Your 1974 Detroit Income Tax Sr lb. Your Estimate of 1975 Derroit Income Tax... 0...

2. Amount of Detroit tncome Tax to ‘be withheld or other credit expected in 1975........... Soe toe

THIS 3. ESTIMATED TAX (line 1b less line 2) 220 ee een
4, Computation of instalment: Cheek Due Date of declaration below and enter portion of line 3 as indicated:

copy G Apr. 30; 1975-1/4; C] June 30, 1975~—1/3; | Sept. 30, 1975—1/2; Cj Jan. 31, 1976—100% = | Pe
: 5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit ——_

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 jess line 5)....... cet ee ee eee

FOR

“YOUR

. IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

RECORDS

MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” : This declaration of estimated tax is not a Tax Return,
AND MAIL WITH DECLARATION TO: . : . .

FINANCE DEPARTMENT — INCOME TAX DIVISION DATE
104 CITY-COUNTY BUILDING
DETROIT, MICHIGAN 48226

f DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE

D-1040-ES ’ CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX: 57
~ For Calendar Year 1975 or Fiseal Year Ending.............. pW... 975
N eo)
AMES) om PRINT BUI ye ALES Ae. Y UR SOCIAL SECURITY NUMBER I CHECK TYPE OF DECLARATION

Oaks é F FEM = [C INDIVIDUAL
ISI BS LIV ELP ALOIS | SPOUSE’S SOCIAL SECURITY NUMBER) b- CORPORATION

PARTNERSHIP
cit STATE POSTAL ZIP CODE a
"Deters im MENiGan 334 een Cl one

la, Your 1974 Detroit Income Tax $... 367. 34, lb. Your Estimate of 1975 Detroit Income Tax........
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975............ beens
3, ESTIMATED TAX (lime 1b fess fine 2) 22.02 ee ee ee eee ee
4, Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
Ki Apr. 30, 1975-1/4; [J June 30, 1975-1/3; CJ Sept. 30, 1975—1/2; {J} Jan. 31, 1976-100%
+ bess: Amount of overpayment on 1974 return which you elected to. claim as a credit «=§ —————-_enremnae °1s
6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5). 0c ee eee

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
| CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.

DOCUMENT LOCATOR NUMBER
un

‘iqnaiuen of Texpoyer, Spouse alo it joint declaration. . . . DATE

NW 88326 Docld:32245535 Page 239

SCHEDULE = — SHAREHNOLDE

mS SHARE CF

(if additional space is needed, attach sciecdule)

(1)

Name and Address of Each Shareholder

aE Rae

WIYGT OA Bs So

(2)

Number

Sipe eeeeeseres

Social Socurity

INCOME AND CAGE

(3)
Nurmmivar of
Shares

, ; (7)

(4)
Amount taxable as ordinary
income (schedule K, total
of lines 4 and 8 US.
1120-S)

schedule B, line 6

NW 88326 Docld:32245535 Page 240

(5)
Distributive income from
page 1, line 5, or page 2,

bf BE

(6)
Amount to be used by share-
hoider on Mi-1040 (enter on
page 2, schedule 1, line 37 or
on page 2, schedule 2, line 46)
difference between column 4
and column 5 (see instructions)

Enter here and on forra
Mi-1040, pase 71, line 25
each shareholtcor’s pro-
portionate share of per-
sonal property taxes
paid on inventories or
the credit for franchise
fees paid.

(see instructions)


x can enT ae wor Paes a at ‘ . -
een Neher IN Ae IN WE Coie te NN a Na

=" TAX COMPUTATION SCHEDULE rind

“or O-15-DIT-s «Rev. 8-74,

» TOTAL DETROIT INCOME EXPECTED iN 1975 | $ 4
. i , i
7

B EXEMPTIONS ($600.00 FOR EACH EXEMPTION)

C. ESTIMATED DETROIT TAXASLE INCOME (LINE A LESS LINE 8) 1 $ i

OD. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 3 OF 1% OF LINE C. | $ :
ALi OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Tb OF DECLARATION BELOW

D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 197s
: For Calendar Year. 1975 or r Fiscal Year Ending .......... eee fh ee fio
NAME(S) (PRINT OR TYPE)

CHECK TYPE OF DECLARATION

CO INDIVIDUAL
[J] CORPORATION
( PARTNERSHIP
(J OTHER

| i
ADDRESS !

SPOUSES SOCIAL SECURITY NUMBER

KeEP la. Your 1974 Detroit Income Tax $.00ccccccccseg Th. Your Estimate of 1975 Detroit Income Tax........
2. Amount of Detroit income Tax to be withheld or other credit expected in 1975

ciTy STATE POSTAL ZIP CODE

THiS 3. ESTIMATED TAX (line Tb less line 2). 20 we oe, nee ee $—______
: 4, Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated: i
copy Co Apr. 30, 1975-1/4; Cj June 30, 1975-1/3; C5 Sept. 30, 1975-1/2; LL] dan. 31, 1976—100% | Sv Seen Boseaaaee .

5. Less: Amount of overpayment on 1974 return which you elected to claim as @ credit een $ | ;

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 2 eee

FOR $1
YOUR
RECORDS \F You ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tax Return.
AND MAIL WITH DECLARATION TO: 5
FINANCE DEPARTMENT — INCOME TAX OIVISION DATE
104 CITY-COUNTY BUILDING
DETROIT, MICHIGAN 46226 :
oo
q DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE
D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 1G" z
For Calendar Year 1975 or Fiscal Year Ending... cee Fak Ae i975

NAMES) _ {PRINT OR TYPE) es
tae cee A FeO
ADDRESS,

ist

C PARTNERSHIP
(J OTHER

la. four 1974 Detroit Income Tox $ di 44. 2G lb. Your Estimate of 1975 Detroit ‘income Tax

2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975...........

3. ESTIMATED TAX (line 1b iess line 2) Lae Fee . : . ce .

4, Computation of Instailment: Gheck Due Date of declaration below and enter portion of line 3 as indicated:
7a Apr. 30, 1975-1/4; \L. June 30, 1975-1/3; a Sept. 30, 1975—1/2; Li Jan. 31, 1976—100%

5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit LS

AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 20. ... 000,

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

DOCUMENT LOCATOR NUMBER

| CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.
Siynuture of Taxpayer. Spovee aise if joint deciarorion. ‘ . DANE

NW 88326 Docid:32245535 Page 241

Name and Address of Each Shareholder

(4)
Amount taxable as ordinary

a)

12)

Number

Social Security

{3}
Numuar of
Snares

(5)
Distributive income from

(6)
Amount to be used by share-

(7)
Enter here and ‘on form

income (schedule K, total page 1, line 5, or page 2, holder on MI-7040 (enter on Mi-1040, pace 7, line 25
of lines 4 and 8 US. . schedule B, line 6 page 2, schedule 1, line 37 or each snarehoicer’s pra-
1120-S) on page 2, schedule 2, line 46} portionate share of per-
difference between column 4 sonal property = taxes
and column 5 (seo instructions) paid on inventories or
the credit for franchise
fees paid,
(see instructions)
(SF 169. 6 165.9 cot
(io) S34. 69 4169.69 es
(c)
(d)
{e)
(f) .
. .
{g)
(h)

(j)

NW 85326 Dochd:32245535 Page 242

ON e e | a eed

rR ED CY Ge Beth GEC AON Ge ESTIVLR ES UNC Oi TAK A ae

ee ‘ . yi,

TAK COMPUTATION SCHEDULE ; ad

C of O-15-DiT-J (Rev. 8-74)

A. TOTAL DETROIT INCOME EXPECTED IN 1975 ; ; 5 i
B. EXEMPTIONS (3600.00 FOR EACH: EXEMPTION) =~ ; $
C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 3) $
D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER % OF 1% OF LINE C. $ i
ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW i

D-3040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 1975
afd ow

(PRINT OR TYPE)

NAME(S)

CHECK TYPE OF DECLARATION
C7 INDIVIDUAL ;

[ CORPORATION
( PARTNERSHIP

ADDRESS

POSTAL ZIP CODE

lat Your 1974 Detroit income Tax $.0. ee ; 1b, Your Estimate of 1975 Detroit Income Tax........
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975........... ee
THIS 3. ESTIMATED TAX (line 1b less fine 2) 00000 e eben bbe t beet eee nes
4, Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
COPY {7} Apr. 30, 1975-1/4; [] June 30, 1975-1/3; [J Sept. 30, 1975-1/2; C] Jan. 31, 1976—-100% |S
5. Less: Amount of overpayment on 1974 return which you elected to claim as a credit © me
6, AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5). 0.00.0. eee

FOR -
YOUR
RECORDS IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” , This declaration of estimated tax is not a Tox Return.
AND MAIL WITH DECLARATION TO: . :
FINANCE DEPARTMENT — INCOME TAX DIVISION : ; . DATE
104 CITY-COUNTY BUILDING ;
DETROIT, MICHIGAN 48226 5
{ DETACH ON PERFORATION AND SEND: FORM BELOW WITH YOUR REMITTANCE
D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX. * Ds
. ~ For Calendar Year 1975 or Fiscal Year Ending)... 1 WY .. [O75 }
NAME(S) (8 (PRINT OR TYPE) - _ CHECK TYPE OF DECLARATION
cS RUMAA SALES ZENS: iB gmat ggg [5 novus
ADDRESS Bo ae EYP ALOIS [AL CORPORATION
MGIlES LIVE ALO

ci _ _ STATE POSTAL ZIP CODE © PARTNERSHIP
ET Po rT ICHIGAM roe C OTHER

la. Your 1974 Detroit Income Tax $... 367.39, lb. Your Estimate of 1975 Detroit Income Tax.
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975
3. ESTIMATED TAX (line 1b jess line 2) 2.0. eee a

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
x Apr. 30, 1975-1/4; L] June 30, 1975-1/3; 0 Sept. 30, 1975-1/2; [) Jan. 31, 1976—100%
. Less: Amount of overpayment on 1974 return which you elected to. claim as a credit ——_—_—_——> °5
6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less fine 5)-

JF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER

DOCUMENT LOCATOR NUMBER
wn

| CERTIFY THAT THIS 1S A CORRECT DECLARATION. . This declaration of estimated tax is not a Tax Return.
‘iqoaiuen of Toapoyer. Spouse ho if joint det tucction. EE -_ “OATE ~

NW 88326 Docid:32245535 Page 243

7 — SHARE

{tf additional space is needed, attach sciieduie)

(1)

Name and Address of Each Shareholder

HOLDEAS SHARE OF INCTME BNO CAGES

(Z)
Social Socurity
Number

_ (3)
Nuinoar of
Shares

(b) ... ESTALE...OF... GEOR SE... PIARTYS
FPiuso CHICAGO

(4)
Amount taxable as ordinary
income (schedule K, total
of lines 4 and 8, U.S.
1120-S)

a}

{a) $ Dw 33),36

(b)

36. 231.37

NW 88326 Docld:32245535 Page 244

(5)
Distributive income from
page 1, line 5, or page 2,
schedule B, line 6

(6)
Amount to be used by share-
holder on Ml-1040 (enter on
page 2, schedule 1, line 37 or
on page 2, schedule 2, line 46}
difference between column 4
and column 5 (see instructions)

(7)

Enter here and on forra
MI-1040, pase 7, line 25
each shareholder's pro-
portionate share of por-
sonal property = taxes
paid on inventories or
the credit for franchise
fees paid.

(see instructions)


pared Cay Ue eeAN IO UE Cotati TNR ce . ry ~
: TAX COMPUTATION SCHzDULE iliond
Cot O-15-DIT-» Rev. 8-74,
"s, TOTAL DETROIT INCOME EXPECTED IN 1975 ls i
I
EXEMPTIONS ($600.00 FOR EACH EXEMPTION) 13
; a Sa SSR
C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE 8) 13 !
t ‘
7 T 7
D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 1% OF 1% OF LINE C. $ :
ALi OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Ib OF DECLARATION BELOW
{
. =
_ D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 4G 7
For Calendar Year 1975 or Fiscal Year Ending... = vey VI. d ~
NAME(S) (PRINT OR TYPE) CHECK TYPE OF DECLARATION

OO INDIVIDUAL
(1 CORPORATION
[ PARTNERSHIP
(J OTHER

i eRe
ADDRESS . j

“City POSTAL ZIP CODE

la. Your 1974 Detroit Income Tax $........cc cee ; lb. Your Estimate of 1975 Detroit Income Tax........
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975.....0...........000...
THis 3. ESTIMATED TAX (line 1b less line 2) . an _ _ _ . Soe . .
4, Computorion of installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
cory wy Apr. 30, 1975—-1/4; Ci June 30, 1975—1/3; 1 Sept. 30, 1975—1/2; (J Jan. 31, 1976-100%
5. ‘ess: Amount of overpayment on 1974 return which you elected to claim as a Crecit — msmmmnnennie
AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... .... be ees .

FOR —————
YOUR
RECORDS (F you ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tax Return.
AND MAIL WITH DECLARATION TO:
FINANCE OEPARTMENT — INCOME TAX DIVISION DATE
104 CITY-COUNTY BUILDING
DETROIT, MICHIGAN 48226
’ DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE -
w-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX” Re te z=

For Calendar Year 1975 or Fiscal Year Ending... vote cee WG, tS/ I

NAM&S) _ (PRINT OR TYPE)
ee SCE ANE SS.

ADORESS, 2135 RIVER NONE

(J INDIVIDUAL
fl CORPORATION
‘Cy PARTNERSHIP
Cc] OTHER

la. Your 1974 Detroit Income Tox 3. Ah 449.26 lb. Your Estimate of 1975 Detroit Income Tax
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975............ . cae
3. ESTIMATED TAX (line 1b less line 2) ..... be eee . eae . ns J
4 Computation of Instailment: Check Due Date of declaration below ond enter portion of line 3 as indicated:
he Apr. 30, 1975—1/4; L. June 30,°1975—1/3; a Sept. 30, 1975—1/2; Li Jan. 31, 1976—100%
5. Less: Amount of overpayment on 1974 return which you elected to claim os a credit
6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 2.00... Le eee

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER
\ CERTIFY THAT THIS 1S A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.

DOCUMENT LOCATOR NUMBER

nt declararion. DATE

Signature of Taxpayer, Spovee aise if jo:

NW 88326 Docid:32245535 Page 245

Cerne nice) CY Gi Celtis Sete AUN Ge Lot eS ave TAK a, "
TAX COMPUTATION SCHEDULE aad
; C of D—-15-DiT-d (Rev. 8-74)
re
A. TOTAL DETROIT INCOME EXPECTED IN 1975 5
1
ey
B. EXEMPTIONS ($600.00 FOR EACH EXEMPTION) $
> = ——
C. ESTIMATED DETROIT TAXABLE INCOME (LINE A LESS LINE B) $
a 7 rs ed
D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 14 OF 1% OF LINE C. a i
ALL OTHER TAXPAYERS ENTER 2% OF LINE C, ENTER TAX HERE AND ON LINE 1b OF DECLARATION BELOW |! !
D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX : 1975
. For Calendar Year 1975 or Fiscal Year Ending... cece 119.

YOUR SOCIAL SECURITY NUMBER CHECK TYPE OF DECLARATION

SPOUSE'S SOCIAL SECURITY NUMBER|LJ CORPORATION

(1 PARTNERSHIP
(] OTHER

NAME(S) (PRINT OR TYPE)

ADDRESS

city 7 STATE . POSTAL ZIP CODE

Ja. Your 1974 Detroit Incame Tax $.......cceeen ; th. Your Estimate of 1975 Detroit Income Tox........
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975..............00 0-000,
THIS 3. ESTIMATED TAX (line Tb fess line 2) 20 ne cee teeny

4. Computation of Installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
copy Ci Apr. 30, 1975=1/4; Z} dune 30, 1975-1/3; [) Sept. 30, 1975-1/2; [J Jan. 31, 1976—160% | Senn

5. Less: Amount of overpayment on 1974 return. which you elected to claim as a credit =< neem
. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 2.000 oe eee eee

KEEP

FOR
YOUR
PLOYER, ENTER EMPLOYER JDENTIFICATI iM
RECORDS IF YOU ARE AN EMPLOYER, 0 NTIFICATION NUMBER
MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” This declaration of estimated tax is not a Tax Return.
AND MAIL WITH DECLARATION TO: :
FINANCE DEPARTMENT — INCOME TAX DIVISION ¥ DATE
104 CITY-COUNTY BUILDING
DETROIT, MICHIGAN 48226
DETACH ON PERFORATION AND SEND FORM BELOW WITH YOUR REMITTANCE
D-1040-ES CITY OF DETROIT ‘DECLARATION OF ESTIMATED INCOME TAX. ‘ 7 |
For Calendar Year 1975 or Fiscal Year Ending)... AWD, { j 75
NAME(S) PRINT OR TYPE) ; CHECK TYPE OF DECLARATION
A POR: IwNe, z
ADDRESS L A ra i (© INDIVIDUAL
) §13S IVERNO! Senn see ua cone
CIty = ce gy ~~ STATE POSTAL ZIP CODE
Depeork | Mricrneart 4eo>) (] OTHER
la. Your 1974 Detroit Income Tax $ I: eee at Tb. Your Estimate of 1975 Detroit Income Tax... . |
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975............ See
3. ESTIMATED TAX (line 1b less line 2) 0000. ee a e

4. Computation of Instaliment: Check Due Dote of declaration below and enter portion of line 3 as indicated:

CJ Apr. 30, 1975-1/4; (] June 30,1975~1/3; (1) Sept. 30, 1975-1/2; } Jan. 31, 1976—100%

. Less: Amount of overpayment on 1974 return which you elected to claim as a credit -_oreeee- >

6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... eee es eo

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER —
} CERTIFY THAT THIS IS A CORRECT DECLARATION. This declaration of estimated tax is not a Tax Return.

DOCUMENT. LOCATOR NUMBER
wn

bigauture of Taapoyer. Spouse also i joint declaration.

aaa PARTS REAR Se womens 0 aa

“DATE.

NW 88326 Docld:32245535 Page 246

Wt UU Sy CY GF ween uii UeeLmaA UN Ue

TAX COMPUTATION SCHEDULE

WN eee GN

€ of D-15-DIT-J (Rev. 8-74)

oo
A. TOTAL DETROIT INCOME EXPECTED IN 1975 s I
t
B. EXEMPTIONS ($600.00 FOR EACH EXEMPTION) “| $ ;
|
C. ESTIMATED DETROIT TAXABLE [NCOME (LINE A LESS LINE B) $ !
—
D. ESTIMATED DETROIT INCOME TAX—NONRESIDENT INDIVIDUALS ENTER 2 OF 1% OF LINE C. $ i
ALL OTHER TAXPAYERS ENTER 2% OF LINE C. ENTER TAX HERE AND ON LINE Ib OF DECLARATION BELOW . !
a!
D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX 197 45

NAME(S)

(PRINT OR TYPE)

C INDIVIDUAL
(J CORPORATION
(PARTNERSHIP

(]. OTHER

ADDRESS

POSTAL ZIP CODE

KEEP ja. Your 1974 Detroit Income Tax $......... ee ; Jb. Your Estimate of 1975 Detroit Income Tax........
2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975...........0...0..005,
THIS 3. ESTIMATED TAX {line ib less line 2) 0.0.0.0 eee
4. Computation of installment: Check Due Date of declaration below and enter portion of line 3 as indicated:
copy ( Apr. 30, 1975-1/4; 1} June 30, 1975-1/3; [] Sept. 30, 1975—1/2; CJ Jan. 31, 1976—100% woes
5. Less: Amount of overpayment on 1974 return which you elected to claim as o crecit eee

FOR & AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less line 5)... 6... weg
Eee

YOUR
P . ENTER EMPLOYER IDENTIFICATI IM

RECORDS IF YOU ARE AN EMPLOYER Oo ON NUMBER

MAKE REMITTANCE PAYABLE TO “TREASURER, CITY OF DETROIT” : This declaration of estimated tax is not a Tax Retura. .

. AND MAIL WITH DECLARATION TO: : :

FINANCE DEPARTMENT — INCOME TAX DIVISION . DATE
. 104 CITY-COUNTY BUILDING ‘
DETROIT, MICHIGAN 48226 :
| DETACH ‘ON PERFORATION AND SEND FORM. BELOW WITH YOUR REMITTANCE
D-1040-ES CITY OF DETROIT DECLARATION OF ESTIMATED INCOME TAX @7E
For Calendar Year 1975 or Fiscal Year Ending... pW. G45
NAME(S) PRINT OR R_TYPE) YOUR SOCIAL SECURITY NUMBER | CHECK TYPE OF DECLARATION
2 . = .

ADDRESS ANCE = Ns =e Se Gea | INoIviDuAL

)E1BS GIVERNOIS [-srouses social secuniTy nunsen| & CORPORATION
CITY eK — STATE POSTAL ZIP CODE Ci PARTNERSHIP

repro rh | MIictHiGaadr Ueaoy (J OTHER

la. Your 1974 Detroit Income Tax $....../. S22... lb, Your Estimate of 1975 Detroit Income Tax........

2. Amount of Detroit Income Tax to be withheld or other credit expected in 1975 Se ee

3. ESTIMATED TAX (line 1b less line 2) 00.0000 ee ees .e

4. Computation of Instaliment: Check Due Dote of declaration below and enter portion of line 3 as indicoted:

i
$ /O0;99
CJ Apr. 30, 1975-1/4; [] dune 30, 1975-1/3; C1 Sept. 30, 1975-1/2; Ci Jan. 31, 1976—100% Seen ss
. Less: Amount of overpayment on 1974 return which you elected to claim asa cred?) ——————— els G t eos
6. AMOUNT TO BE PAID WITH THIS DECLARATION (line 4 less fine 5)- 0.000.000 c ec ee els BeUr7

IF YOU ARE AN EMPLOYER, ENTER EMPLOYER IDENTIFICATION NUMBER .
| CERTIFY THAT THIS 1S A CORRECT DECLARATION, This declaration of estimated tax is not a Tax Return.

DOCUMENT LOCATOR NUMBER
a

Siynuture of Tonpayer. Spouse, also it joint declaration. : OATE

6

NW 88326 Docld:32245535 Page 247

